© 2005, Elsevier Limited. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department, 1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone: (+1) 215 239 3804; fax: (+1) 215 239 3805; or, e-mail:
[email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Support and contact’ and then ‘Copyright and Permission’. First published 2005 ISBN 0702027677 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress
Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the publisher nor the author assumes any liability for any injury and/or damage. The Publisher
Printed in China
vii
Preface
Behavioural medicine is an important branch of both human and veterinary medicine. When we are unwell friends or family members may notice that we have become moody, irritable or depressed, while work colleagues may pick up on a drop in our performance or concentration and these behavioural, rather than physical signs may be the reason that medical assistance is sought. Once we have been successfully treated our mood often lifts and our behaviour returns to normal. In some circumstances we may consider it perfectly acceptable to use illness as an excuse for our own bad behaviour while in others we may be acutely aware of the need to mask our illness and put on a show of strength in order to conceal our vulnerabilities. In a veterinary context things are not so different and when companion animals are ill they often obtain medical help primarily because their owner has noticed a change in their behaviour. Owners often refer to general signs of illness such as mood changes, irritability and depression and as vets we are frequently presented with animals that are reportedly unwell on the basis of these general signs. It is up to us to investigate the cause. In other cases more specific medical symptoms may be reported, such as polydypsia and lameness, but these are merely behavioural adaptations that enable the animal to continue to function despite the presence of pathology, so once again behavioural medicine is involved. The expression of signs of illness is very dependent on the ethology of the species and in a social species, such as the dog, it can be potentially risky to show signs of vulnerability that might affect rank within the group, so signs of illness are often concealed. One possible result of this is that the ill individual may become more aggressive in order to deter competition that
may reveal weakness. In companion dogs this might translate into increased aggressive reactions towards other dogs in the home, unfamiliar dogs met on a walk, children or the adult owner. Direct signs of the physical cause of the change in aggressiveness may be suppressed, but there is still a very obvious change in behaviour and this may be the only reason why an owner approaches the veterinary surgeon for advice. This strong link between behaviour and disease makes it essential that we ask questions about behaviour as part of our routine consultations and investigate potential medical causes when behavioural symptoms are presented. Unfortunately behavioural medicine forms only a tiny part of the curriculum for most universities and colleges that teach veterinary medicine or nursing and it is easy to be overwhelmed at first by the range and type of behavioural problems that clients bring to us in general practice. Certainly there may be some that could be referred straight away but in most cases the vet will feel obliged to offer some first line advice and this stage of dealing with a behaviour case is vitally important since mishandling can lead to serious consequences in terms of animal suffering, human injury or litigation. In this book we have adopted a particular style and layout that we hope will make it more accessible for readers in a busy practice environment. For example, key information on problem prevention and immediate advice to give to clients is placed into easily located text boxes within each section. We deliberately chose not to break up the text with references because we wanted the text to be easily read but further reading suggestions are included for those who wish to expand their behavioural knowledge and look at some of the primary research in this fascinating field.
ix
Acknowledgements
I would like to thank my wife, family and friends for continuing to offer support and advice throughout every foul mood I experienced whilst writing my sections of this book. I would particularly like to thank my mother, Jo Bowen, for her incredibly diligent and patient proof reading. Without her contribution my sections of the book would never have been completed. Jon Bowen
Thanks to my two sons, Matthew and David, and to my parents. Without their support this book would certainly not have been written. Thanks also to all of the staff at the practice for their support and to Jon’s mum for her much appreciated proof reading. Sarah Heath We would both like to thank Elsevier for giving us the opportunity to produce this book and hopefully encourage the study of behavioural medicine in a veterinary context.
3
Chapter 1
Providing a practical behavioural service
CHAPTER CONTENTS Dealing with behavioural issues 3 Providing a practical behavioural service 4 Increasing owner awareness of the behavioural service 4 Catering for the prospective owner 4 Providing a behavioural advice service for breeders 5 The new owner 8 Dealing with behaviour cases 10 The behavioural consultation 10 Getting down to the problem 11 Making the diagnosis 12 Providing informed referral 12 Making the link with disease 12 Offering options 13 All part of the service 14
DEALING WITH BEHAVIOURAL ISSUES When considering the incorporation of behaviour into general practice, veterinary surgeons are often concerned about the level of time commitment that will be required to deal with individual cases. They are also concerned about the lack of education that they received at undergraduate level in the field of companion animal behaviour and are aware of the need to be familiar with the natural behaviour patterns of the common companion animal species, as well as with the possible link between human behaviour and inappropriate animal responses. These concerns often prevent practices from pushing behaviour to the top of their agenda, but dealing with specific behavioural cases is only one aspect of providing a behavioural service and veterinary practices can significantly improve their service to their clients by offering behavioural advice in a variety of other ways. Providing a behavioural service has numerous benefits both for the clients and the practice; in particular it can: ●
●
●
● ●
improve the quality of life for animal and owner alike and so increase client appreciation of the practice make life easier in the consulting room and increase job satisfaction for both vets and nurses provide a valuable extension of the veterinary nurse’s role encourage a greater rapport with clients be financially rewarding, either directly through offering behavioural consultations or indirectly by decreasing the possibility of euthanasia of otherwise healthy young pets.
An obligation to be involved The high incidence of behavioural problems in the domestic pet population is highlighted by research which suggests that the primary reason for euthanasia in young, physically healthy animals is concern over an aspect of their behaviour. The welfare concerns that such research raises lead to an obligation on the part of the veterinary profession to be
4
PRACTICE TIPS
involved in the prevention and treatment of behavioural disorders and in the education of those that breed, rear, and own domestic pets.
PROVIDING A PRACTICAL BEHAVIOURAL SERVICE Although behavioural consultations with clients already experiencing problems with their pets is often highlighted as the main emphasis of behavioural practice, this is not necessarily the case and a more holistic view of behavioural medicine is needed within general practice. Providing a behavioural service involves a number of elements including: ●
●
● ● ●
●
●
●
making clients aware that behavioural issues are taken seriously within the practice providing pet selection interviews and literature to assist prospective owners in choosing their pet providing a behavioural advice service for breeders providing behavioural advice for new owners organising kitten information evenings and puppy parties offering informed referral to a veterinary behaviourist or behaviour counsellor providing behaviour-based information clinics and literature for clients offering behavioural consultations for individual clients and their pets.
Increasing owner awareness of the behavioural service It is necessary to take every opportunity to inform the clients of the behaviour services that the practice has to offer. Simply by mentioning behaviour during a consultation, and by showing interest and concern about the issues that owners face, the veterinary practice can help clients to recognise where there may be a problem and encourage them to seek suitable advice. Waiting room space is often sadly underused and there are a number of ways in which this area can be utilised to demonstrate that the veterinary practice has a positive attitude to behavioural issues.
Posters can be a useful way of getting the message across, and perhaps provoking discussion between clients as they wait. They can advertise the fact that the practice acknowledges behavioural problems and can offer help with their solution, which will often be enough to encourage clients to mention their concerns to both the vet and the nursing staff, thereby opening up the possibility of taking the subject further. Merchandise such as books on companion animal behaviour and a range of behaviour-related products (for example, headcollars, clickers, and bitter apple spray), in the reception area will often quietly increase the profile of behaviour within the practice and make clients more aware of the services the practice can offer. It can also provide an
opportunity for the reception staff to mention behavioural topics as they sell the items, which can often lead to owners feeling able to discuss specific behavioural issues.
Booklets and magazines with a behavioural message can be left on the tables in the waiting room. Most owners are grateful for something interesting to read or look at while they are waiting for an appointment and the presence of literature with a behavioural slant increases awareness that the practice is interested in behavioural issues. Practice copies of the booklets that are stocked as merchandise can help to promote sales by allowing clients time to leaf through them. Handouts and information sheets are used in many practices to convey important messages to clients on a wide variety of subjects, including dental care, worming and vaccination. It is easy to include behaviour in these handouts and, by leaving them in the waiting room for clients to help themselves, the very common problem of people being reluctant to admit that they are concerned about their pet’s behaviour can be overcome. The practice address and telephone number should be clearly printed on the leaflets and, if possible, the name of a member of the practice staff who can be contacted to discuss the problem should also be given. A personal touch is extremely beneficial in behavioural cases since the owners are often at the end of their tether and many are experiencing feelings of guilt, shame and failure as a result of their pet’s behaviour. It is therefore essential to offer relevant and helpful advice in a friendly and welcoming manner.
Videos can be played in the waiting room area and used not only to impart some information about behaviour, but also to inform clients that behaviour is taken seriously in this practice. Videos can then be lent, hired out or even sold by the practice. Ideally, a receptionist should be constantly available so that any questions that the client wishes to raise as a result of seeing posters or reading behavioural material can either be answered there and then, or the client can be advised to mention the matter to the vet once they get into the consulting room.
Catering for the prospective owner One of the most disheartening aspects of working in the field of veterinary behaviour is the fact that so many of the problems that are being presented could have been avoided. Taking the time to consider the way in which domestic pets are bred and reared is obviously important, but it is not the only possible approach in the prevention of behavioural problems and working with prospective owners can be a very rewarding exercise for the veterinary practice. The main objective is to assist people in choosing the pet that is best suited to their requirements and which offers them the best potential for a long and mutually rewarding
Providing a practical behavioural service
relationship. In order to achieve this it is worth taking time to determine the prospective owner’s expectations and help them to assess the commitment of pet ownership in realistic terms. There will be a number of factors that need to be considered and it is important to steer people away from misguided choices and give clearly justifiable reasons for the selection that is advised. Many prospective owners will not have taken the time to sit down and rationally evaluate their reasons for wanting a pet and it can be very helpful to talk them through this process. Pointing out the possible considerations in terms of the species, breed, age, and sex of the potential pet can help to put the decision in perspective and can prevent distressing mismatches. Since many owners are still unaware that veterinary practices can offer any support or guidance before a pet is acquired, it is important to increase awareness by displaying posters in the waiting room. Drawing attention to the existence of pet selection interviews can emphasise the importance of the decision-making process and encourage prospective owners to think carefully about the issues involved. These interviews are often carried out by the veterinary nurse and they offer another way in which nursing staff can make a valuable contribution to the overall preventative health care programme that the practice can provide. If the practice does not have the time to offer faceto-face interviews for this purpose, it is possible to produce handouts which can be available at the reception desk. At pet selection interviews it is important to discuss all the factors that can influence the choice of pet, and these must include practical considerations of time and money as well as emotional factors such as personal preferences. Advice will not be limited to dogs and cats and consideration of other species should be encouraged if they are more suited to the person’s personal circumstances. However, for the purpose of this book the option of only feline or canine companions will be discussed. Cats and dogs have different attributes to offer but neither is any ‘easier’ to care for or any ‘less trouble’ than the other. Ownership of either species brings with it very real responsibilities and one of the roles of the veterinary practice is to make those responsibilities known to the prospective owner. Some of the main considerations for the prospective owner are as follows: ● ● ● ●
Breed Sex Age Source
: mixed breed or purebred : male, female, entire, neutered : adult, kitten, puppy : breeder (professional or private), rescue centre
Once a selection has been made the prospective owner will need some guidelines in order to avoid the common pitfalls encountered when selecting a pet. Advice sheets covering the most important considerations for owners who are about to take on a puppy or kitten, or give a home to an adult dog or cat, can make
valuable additions to the practice literature (see Figs 1.1 and 1.2 for sample guidelines). Advice for prospective owners electing to take on an adult. Carefully consider the source of your new pet. If you are taking on a rescue animal visit the rescue centre before you are actually looking for a pet and observe their facilities and ask about their re-homing policy. Try to ensure that your selection is ruled by your head and not your heart. Resist the temptation to take an animal home on impulse and do not base your selection purely on appearance − there is a lot of information that you need to find out. If possible gain as much information as possible about the animal’s history. Find out as much as possible about the environment in which it lived and the human composition of its previous household. Be patient in the early stages after adoption, but do start as you mean to go on and consistently apply any house rules that you wish to establish. Expect a honeymoon period − it can take three or four weeks for behavioural problems to show. Do not fall into the trap of selecting an adult rather than a puppy or kitten because they are ‘less work’ − this is not necessarily true.
Figure 1.1 Advice for prospective owners electing to take on an adult pet.
Providing a behavioural advice service for breeders Much has been written about the responsibility of breeders with regard to the successful rearing of pets that are suited to life in a human context and yet the preventable behaviour problems, which prohibit these animals from integrating into society, remain at an unacceptable level. Education is vital and the veterinary profession is well-placed to interface with breeders and offer practical and relevant advice regarding breeding stock selection, early socialisation, habituation, and selection of appropriate homes. The common aim of the breeder and veterinary practice should be the production of emotionally stable puppies and kittens who can adapt to whatever lifestyle they are offered and can successfully coexist with their own and other species. Veterinary practices are suitably placed to offer the necessary advice to achieve this aim, and working with breeders in this area can be very rewarding. Providing preventive behavioural advice for the breeder will involve: ●
●
studying the breeding programme and offering practical advice on behaviour-based selection of breeding stock observing current housing and advising on its effects on the behaviour of breeding bitches and stud dogs and on the behavioural development of puppies
5
6
PRACTICE TIPS
Advice for prospective owners electing to take on a puppy or kitten. Carefully consider the choice of pet. The species, breed, age and sex are all important. Be realistic in expectations concerning financial and time commitments. Do not underestimate the work involved in caring for a new puppy or kitten. Do not consider obtaining a kitten or puppy from a pet shop or from an outlet that claims to sell a range of different breeds which are not connected in any logical manner. Take the time to locate a reputable breeder or visit a reputable rescue organisation. If necessary be prepared to travel. Ask to meet the dam and, if possible, the sire. Spend time observing the litter at play and watching just how they interact. Look for a litter where all of the puppies or kittens are outgoing and confident. Observe the behaviour of other animals at the breeder’s premises, or visit owners of dogs and cats from previous litters, as this will give an indication of the success of socialisation and habituation programmes carried out by the breeder. Observe reactions to novel stimuli in their environment, such as a new toy, and to strange and unexpected sounds such as the gentle rattling of car keys. In an ideal situation, the puppies or kittens should appear surprised but quickly recover and go to investigate. Handle the puppies or kittens and see their reaction to strange people. The way in which a young animal responds to being handled and examined gives a good indication of the success of socialisation. Once you have selected a kitten or puppy, arrange to visit it as often as possible prior to collection in order to build up a relationship with your new pet. Do not be too impressed with immaculate and clinically clean premises if they are totally devoid of stimulation. Cleanliness is important, but so too is habituation.
Figure 1.2 Advice for prospective owners electing to take on a puppy or kitten.
●
assessing current rearing methods and offering advice on socialisation and habituation programmes.
These aims can be achieved through a variety of means including: ●
● ●
●
Providing access to suitable literature through a practice library system Preparing advice sheets for breeders on major issues Setting out socialisation and habituation programmes for breeders Organising evening meetings with outside speakers who are of particular interest to breeders.
The major issues for most breeders are the selection of breeding stock, the social and physical environment for rearing of puppies and kittens and the communication with new owners to ensure the continuation of socialisation and habituation in the new home. Veterinary practices need to be prepared to spend time getting alongside breeders and understanding their criteria before being able to offer advice which is tailor-made for that breeder and their specific circumstances. The production of client information sheets with advice for breeders (Fig. 1.3) is one way in which the subject of behavioural considerations in breeding establishments can be raised. These can act as a springboard for more in-depth conversations and the delivery of more specific advice. However, puppies and kittens are not only reared and sold through commercial enterprises and veterinary prac-
tices also need to be involved in offering practical advice and support to owners who decide to have one-off litters from family pets. This is more of an issue in a canine context since human control over breeding of domestic cats is often limited and the number of non-commercially reared pedigree cat litters is minimal. The provision of advice regarding the suitability of bitches for breeding is a very important area of behavioural problem prevention where veterinary practices can easily become involved. It is impossible to prevent someone from using an unsuitable bitch for breeding, but many errors are made through ignorance (rather than deliberate irresponsibility) and education of owners as to the heritable nature of fearrelated behaviour and the importance of using only emotionally stable individuals in breeding programmes cannot be overemphasised. There are numerous opportunities to give advice about breeding programmes but vaccination appointments – both primary and booster – are particularly useful times to consider the issue of breeding. For owners of new puppies the prospect of allowing their bitch to give birth, or their dog to have one taste of the good life and sire one litter may seem like the kindest thing to do, but practical considerations regarding the responsibility of rearing and finding homes for a number of lively young pups may not have been made. By raising this subject at the time of the first vaccination and providing a client handout with guidelines for people considering using their pet dogs for breeding (Fig. 1.4), the
Providing a practical behavioural service
Advice for breeders. When deciding on breeding programmes, temperament of both dam and sire need to be considered. This is especially relevant in feline breeding where the paternal effect on the behavioural characteristic of boldness is well documented. Once a litter has arrived ensure that the puppies and kittens become accustomed to being handled. Handling must take place in an appropriate manner and it is important to take care not to distress the dam. Gradually increase the amount of contact with people. Start with people known to the dam and gradually introduce less familiar people as well as a wide range of individuals: old and young, male and female. Of course, it is essential that adequate precautions are taken at all times to prevent introduction of disease. Encourage new owners to come and visit their pet in the breeding environment as often as possible before they take it home. Introduce the puppies and kittens to a wide range of environmental stimuli, including everyday household noises such as washing machines. Ideally, there should be an opportunity for the puppies and kittens to experience home life as early as possible, even if it is only for a few hours a few times a week. Where it is totally impossible to do so, use tape recordings of common sounds, such as children playing, doorbells, vacuum cleaners and tumble driers, which can be played in the breeding area in those crucial early weeks. Provide a wide range of stimulation through provision of species-appropriate toys and activities, as well as exposure to human-related stimuli. Design breeding establishment buildings to take into account not only disease prevention and ease of management but also behavioural considerations. Inform prospective new owners of the importance of continuing the socialisation and habituation process in the new home.
Figure 1.3 Advice for breeders.
General guidelines for clients considering using their pet dogs for breeding. Question the motivation for wanting a litter – only go ahead if the motivations are clear, identifiable and justifiable. Consider the issue of re-homing – is there a suitable and available market for the puppies?
commitment involved, it is important for the veterinary practice to be on hand to offer advice and practical support. The most important considerations are: ● ● ●
Remember that the sire will influence the behaviour of his pups even if he never meets them, and consider the temperament of the stud dog as well as the bitch. Carry out a small behavioural test on prospective breeding dogs and bitches to determine their level of suitability for breeding. Remember that it is not only the actual level of fear responses that an individual exhibits that is significant but also the recovery time when the fear-inducing stimulus is either removed or is proven to be non-threatening. Do not consider breeding from a nervous or aggressive bitch or dog. Be prepared for the phenomenal commitment involved in providing a suitable physical, social and emotional environment for the rearing of young puppies.
Figure 1.4 General guidelines for clients considering using their pet dogs for breeding.
veterinary practice can help to improve the level of thought that is given to the subject and perhaps dissuade owners from breeding from pet bitches who are unsuitable for the purpose. If clients are determined to go ahead with the breeding programme and they have given due consideration to the
●
●
selection of dam and sire provision of appropriate health care provision of suitable physical housing, which provides for the five basic freedoms: freedom from thermal and physical distress, freedom from pain and injury, freedom from hunger and malnutrition, freedom from fear and stress and freedom to express most normal behaviour provision of a social and emotional environment that supports the behavioural development of the puppies and kittens and maximises the emotional stability of the animals reared establishment of a socialisation and habituation programme which is started at the breeder’s premises and is then continued by the new owner in the new home. Tick chart checklists can easily be constructed by the practice and distributed to breeders but the availability of commercially prepared socialisation and habituation checklists for breeders of puppies and kittens makes this unnecessary. Ideally one of the practice staff should be available to explain how these charts should be used, but booklets, which accompany these products, can be selfexplanatory.
For those clients who are in the process of rearing litters of puppies or kittens, it is useful to provide guidelines as to the most important experiences for those animals while they are still on the breeder ’s premises (Box 1.1).
7
8
PRACTICE TIPS
Box 1.1 Important experiences for puppies and kittens while still on the breeder’s premises ●
●
●
●
Interaction with other dogs. The dam and littermates will be the first contacts and other dogs on the premises, possibly including the sire, can also be incorporated into the socialisation programme. Introduction to people including men, women and children. Varying appearances, clothing and activity should be included in these introductions. Auditory, visual and tactile stimulation. This can be provided through the use of toys and games, and by exposure to normal everyday human activities. Introduction to the concept of solitude. There should be very short and controlled periods of being alone.
Box 1.3 Examples of behavioural issues that need to be raised with new kitten owners ●
● ●
●
● ●
●
●
Providing suitable introductions to people and other animals Accustoming the kitten to appropriate human handling Providing a complex environment and introduction to a variety of experiences Providing suitable litter facilities to facilitate litter training Introducing suitable games and toys Teaching the kitten some basic behaviours such as coming when called Introducing the kitten to using a cat flap and wearing an appropriate collar Preventing specific behaviour problems such as indoor scratching
The new owner Once owners have acquired their new pet, the veterinary practice has an essential role in providing preventive behavioural advice. It is a good idea to advise clients on how to socialise and habituate their puppy or kitten successfully as soon as they contact the practice, and while they are at a very receptive stage in their relationship with their pet. It is important to emphasise that these vital processes can begin while the vaccination programme is in progress and that a high percentage of behavioural problems can be prevented if puppies, kittens, and young of other companion animal species are given the correct experiences early in life. However, socialisation and habituation are not the only behavioural issues of interest to new owners and veterinary practices are called on to give advice on topics ranging from house-training puppies to teaching kittens to use a cat flap and from teaching puppies to cope with being alone to introducing suitable forms of play between owner and cat (Boxes 1.2 and 1.3).
Box 1.2 Examples of behavioural issues that need to be raised with new puppy owners ●
●
● ● ●
● ●
●
Providing suitable introductions to people and other animals Providing a complex environment and introduction to a variety of experiences Introducing suitable toys and games Using successful house-training techniques Reinforcing appropriate behaviours when greeting people and other dogs Teaching basic obedience, including sit, stay and recall Preventing specific behaviour problems such as play biting Introducing the puppy to the experience of being alone
Socialisation and habituation The importance of these two processes in the preparation of puppies and kittens for life in a domestic environment has been highlighted over recent years and far more is now known about the effects of early-life experiences on future behaviour. The most sensitive period of behavioural development in terms of socialisation and habituation is from 2 to 7 weeks in the kitten and from 4 to 14 weeks in the puppy (with particular emphasis on the period from 4 to 8 weeks). It is important to understand that this is a sensitive period rather than a critical one and therefore preferences can be formed and altered outside of these boundaries, but receptivity to socialisation and habituation is at its maximum at this stage of development and it is therefore advisable to take advantage of this biological window of opportunity. The issue of socialisation and habituation has been most widely publicised within the canine context but cats also need to experience suitable socialisation and habituation if they are to develop into family pets and respond to the ever-changing demands that are made of them in terms of their role as companion animals. Socialisation: The process whereby an animal learns how to recognise and interact with its own species and the species with which it cohabits. Kittens and puppies need to be introduced to a wide range of people and other animals during their socialisation period (Fig 1.5). In the case of kittens, it has been shown that introduction to at least four different people is needed before there is a generalised acceptance of human company, and it is recommended that these people represent a range of ages, sexes and appearances in order to maximise the beneficial effects of the socialisation process. For the domestic cat, the aim is for them to be able to have a mutually beneficial relationship with their owners and to
Providing a practical behavioural service
Recommended socialisation experiences. Meeting a variety of people: Men Women Young people – babies, children, and teenagers Elderly people Delivery people – milkman, postman People of varying personal appearance – wearing glasses, with and without a beard People in a variety of clothing – everyday clothes, uniforms, veterinary practice clothing People with various modes of transport – walking, riding a bicycle, on a skateboard, jogging, pushing a pram or pushchair Meeting a variety of animals: Cats Dogs Livestock Horses Small domestic pets, e.g., rabbits, guinea pigs, caged birds When different species are being introduced, it is important to remember the role of prey and predator and to avoid unnecessary stress for either species.
Figure 1.5 Recommended socialisation experiences.
be able to cope with the normal range of human visitors to the home and interact with them without fear. When socialising puppies, it is important to remember that dogs need to cope not only with the family and their visitors but also with delivery people who approach the home and with the vast range of human appearances that they may encounter when they are taken away from the home for exercise. It is therefore important to pay attention to varying appearances when implementing socialisation programmes for puppies and to include people with beards, glasses, walking sticks, people in wheelchairs and those carrying boxes or other heavy loads.
One of the main aims of the socialisation process is for pet dogs and cats to be better-equipped to cope with life in a human context and to be able to fulfil their owner’s expectations of a companion animal. For the dog this is relatively straightforward since it is a pack animal with an inbuilt desire for social interaction. It also has a hierarchical structure to its society, which is not dissimilar to our own, and this enables it to integrate into human social structure relatively easily. In contrast, the cat comes from a very different social background and has no ultimate need for physical interaction with its owners. It is a social animal but the basis of its social behaviour in the wild is the cooperative rearing of young and, when it comes to ultimate individual survival, the cat is a solitary creature. These fundamental differences in ethology have important implications for the socialisation of kittens and, in order for domestic cats to appreciate and even value human company, they need exposure to social contact, which prepares them for the expectations of their owners. One of those expectations is close physical interaction and during the socialisation period kittens need to be lifted frequently, gently restrained and touched gently all over their bodies. Such handling prepares them for the cuddling interaction that many owners desire but which is totally alien to a species in which flight is the primary form of defence and the act of being restrained with all four feet off the floor is inherently threatening. Habituation: The process whereby an animal becomes accustomed to non-threatening environmental stimuli and learns to ignore them. Kittens and puppies need to be introduced to a variety of environments during their primary socialisation period and also need to encounter those experiences that are part and parcel of life in a domestic environment (Fig 1.6). For the dog, habituation is particularly important because they will encounter a wide range of environments and experi-
Recommended habituation experiences. Introduction to a variety of environments Veterinary clinic Other people’s houses Railway stations Bus stations Built-up areas Rural areas Recreation areas, such as playgrounds and parks Highways Introduction to a variety of novel objects Children’s accessories, including pushchairs, cots, highchairs, prams Household appliances, such as vacuum cleaners, dishwashers, tumble driers Human toys, including bicycles, dolls, soft toys Animal toys such as chew sticks, squeaky toys Traffic
Figure 1.6 Recommended habituation experiences.
Introduction to a variety of novel sounds Aeroplanes Gunshots Fireworks Thunderstorms Traffic Children and babies Introduction to a variety of experiences Grooming Exercise Veterinary examination Going inside lifts and up and down escalators Travelling in a car and on public transport
9
10
PRACTICE TIPS
ences as adults and their behaviour is likely to impact on other members of society as well as on their owners. In the past, habituation for cats has been overlooked but, as the cat becomes expected to fulfil a role as a primary companion animal, the number of objects, environments and experiences it is likely to encounter in adulthood are increasing. Fear-related behaviour problems are known to be very prevalent in the feline population and, while many owners never seek professional help for these animals, the welfare implications of poor habituation for kittens cannot be overlooked. The range of experiences that are necessary for puppies and kittens are obviously slightly different and not all the examples in Fig. 1.6 apply to both species!
DEALING WITH BEHAVIOUR CASES Advice on dealing with common behavioural problems, such as house-soiling in cats and separation-related problems in dogs, is an essential element of preventive behavioural medicine and can prevent minor problems from escalating into serious issues. It can also form an important part of the information offered by the veterinary practice, either as a first-aid approach or as a prelude to referral in established behavioural problems. Specific behavioural conditions are dealt with in the latter parts of this book but at this point it is worth considering the way to approach a behaviour case if the practice decides to offer a more formal behavioural service and carry out behavioural consultations within the practice (Box 1.4).
The behavioural consultation Due to the nature of behavioural problems and the inevitable relationship between the animal’s environment and its behaviour, it is useful to have as many of the people who live with the animal present during the behavioural consultation as possible. This may mean a ratio of as many as one to four for the counsellor and there can be no doubt that increased numbers of people present can make historytaking all the more difficult. It is likely that there will be disagreements between the members of the family but, as long as these stay within control and do not become too heated, such discussion can be helpful in developing a truer picture of the animal’s individual circumstances and problem.
Box 1.4 ●
●
● ● ● ●
The aims of a behavioural consultation
Investigate potential medical causes of the behavioural change Reach an accurate diagnosis through observation and questioning Get alongside the client Communicate the diagnosis and prognosis to the client Prescribe a treatment regime if appropriate Encourage the client to adhere to the treatment plan via aftercare support
Taking a behavioural history The ability to take a good history is central to all aspects of veterinary work and is arguably the most important skill for a veterinary surgeon to possess. It is essential to be able to differentiate between peripheral information and crucial details. Many veterinary surgeons find the differences between the approach for a medical and a behavioural case somewhat daunting and the sort of information that needs to be obtained and the techniques that are used to obtain it can make history-taking in a behavioural context something of a challenge. However, the aims of a medical and a behavioural consultation are basically the same and behaviour should be seen as a natural extension of veterinary medical practice.
Gathering the relevant information Many people find it useful to work from some form of questionnaire in order to ensure that all the vital information is received, but it is important to tailor the exact format of any consultation to the individual requirements of the particular client. It is essential to guard against the situation where regimented questions prevent the owner from expressing feelings freely and also to avoid the use of leading questions which will provoke an expected, but not necessarily accurate reply.
Keeping things on track Although the aim is to put the client at ease, it is also important to remember that you need to gain the maximum amount of information in the time available and that there should be some structure to the consultation in order to avoid rambling conversations that get nowhere (Box 1.5). A combination of a questionnaire approach and casual dialogue is likely to give the best results.
Determining the client’s perception of the problem At the start, it is important to determine what the problem is from the client’s point of view and how they expect you to be able to help. In many cases, the client will identify more than one problem and it is useful to determine which of these problems is the most troublesome and focus attention on that in the first instance.
Box 1.5 During the consultation the aim is to collect all of the pertinent information about the following areas ● ● ● ●
The Pet The People The Environment The Problem
Providing a practical behavioural service
Don’t just focus on the problem In addition to the obviously important details in terms of signalment and clinical history, it is essential to build up a picture of the animal and its environment, both physical and social. Details about the early life experiences of an individual, together with their genetic makeup, can be highly relevant to a behavioural problem and if the owner has information about the behaviour of other related animals, such as littermates or sire or dam, then this may also be useful. In the case of dogs, details about any initial training may also provide an insight into the owner–pet relationship and information about previous behavioural therapy will be relevant for any species (Box 1.6). Turning attention to the animal’s present situation, it is important to gain as clear a picture as possible of the way that the family concerned operates and how the pet fits into that unit. Details of the daily routine will give vital clues and it is important to ask about the pet’s reactions to the routine of the owners as well as about its own routine: for example, exercise, play sessions and sleep patterns. Diet and feeding regime also need to be considered since the way in which pets are fed can certainly affect their relationships both with each other and with their owners. However, there is a lack of sound scientific research to support the anecdotal reports of a clear link between diet and behaviour and far more work is needed in this area. The next area that needs to be explored is that of the human–pet interactions within the family unit. It is useful to ask the client to describe in their own words their relationship with their pet and its relationship with them. This will often give a very good idea of the basis of the bond between them and may provide a vital clue as to the cause of the specific problem in question. It is increasingly being recognised that the way in which owners interact with their pets, and even with each other, can have marked effects on an animal’s behaviour and it is not uncommon for there to be a direct link between tensions within the home and development of behavioural problems in pets. The animal’s temperament is obviously of fundamental importance and information can be gained both by asking the client to give a description of it, as they perceive it, and by using observational skills during the consultation to
Box 1.6
draw your own conclusions. Equally important is information about any alterations in temperament that the owner has noticed over recent weeks and any situations that the owner believes to trigger such alterations.
Getting down to the problem Obtaining an accurate description of the specific behaviour problem is often difficult but it is a key step toward a diagnosis. Obviously, any description given by the client is going to be dependent upon their personal interpretation of the problem and this does provide room for error. Misinterpretation of the animal’s posture and facial expressions may easily lead to confusion as to the motivation for the behaviour and, although much of the information that the counsellor requires can be obtained by talking extensively with the client, additional (and often vital) details will be obtained by careful observation of the animal’s behaviour. First hand observation of the specific behaviour is obviously ideal but video footage can also be extremely useful. There is a great deal of benefit to be derived from comparing the information acquired by observation and that provided verbally by the owner and, if there is extreme conflict between the two, it may be necessary to alter the interviewing technique in order to obtain a more accurate picture (Box 1.7). As well as a description of the behaviour itself, it is also necessary to find out about the circumstances surrounding the onset of the behaviour and any external factors which may have acted as catalysts for the problem. The frequency with which the behaviour is exhibited, as well as the way in which it appears to be developing, are also important factors to be considered. Predictability can be a useful factor in determining prognosis and it is important to remember that a behaviour that is a logical consequence of some trigger perceived by the animal may appear to the owner to be random and unpredictable. Finally, the client’s response to the behavioural problem needs to be considered since this can be of crucial significance, not only with regard to the perpetuation of a problem through some form of reward, be it accidental or intentional, but also when considering the triggering of a specific problem. Any implication that the owner may have contributed to the problem will only serve to make them defensive and hamper the consultation process, so the way in which this area is investigated can be crucial to success.
General Behavioural History
Animal’s details Client’s details Relevant clinical history Present medication Previous behavioural therapy Initial training Previous training
Genetic influences Early experiences Daily routines Diet and feeding regime Human–pet interactions Genetic makeup Animal’s overall temperament
Box 1.7 Relevant information about the specific problem Detailed description Onset Development Client’s response
Frequency Predictability
11
12
PRACTICE TIPS
Beginning to realise that your own actions may have unwittingly contributed to the problem is very different from feeling that you are being accused of being responsible for your pet’s behaviour.
Making the diagnosis Once all the information has been gathered, you should be in a position to start analysing that information and reaching your diagnosis. As with any veterinary treatment, the aim is to deal with the causes of the problem and not simply the symptoms and, therefore, exploring why the behaviour has developed is an integral part of the consultation (Box 1.8).
Box 1.8 Possible causes of behavioural problems ●
● ●
●
Normal species-specific behaviour in an inappropriate context Inappropriate learned responses Behavioural changes resulting from physical or mental illness A combination of the above
Providing informed referral In some cases, the practice may be able to offer the necessary expertise to deal with the case in-house; but it is not unusual for practices to consider referral for behavioural cases and, when this option is favoured, it is important to ensure that the referral is beneficial to all involved. Referral in a behavioural context is no different from the process in any other veterinary discipline and appropriate transfer of information from the referring veterinary surgeon to the behaviourist involved is essential. When the referral is to a veterinary behaviourist, it is best to provide a full copy of the animal’s medical history over the previous 12 months, together with any significant health information from before that. The results of any medical investigations that have been performed should also be supplied. Veterinary surgeons are reminded that they do need to obtain the consent of the owner to provide this information to a third party. If referral is being made to a nonveterinary behaviourist, a written summary of the animal’s relevant medical history should be provided. Informed referral involves a basic level of understanding of behavioural medicine and, just as a veterinary surgeon referring a complex orthopaedic case would be well aware of the surgery required to deal with the problem, so the veterinary surgeon referring a behavioural case should do so with some level of knowledge and understanding, rather than seeing it as an easy option for difficult patients. Referral involves the transfer of a patient to another party for further investigation of a behavioural problem,
but this does not exclude the primary practitioner from carrying out the initial veterinary examination and health check. Animals presenting with behavioural symptoms should always be examined for potential physical causes and thorough physical examination is the minimum input required prior to referral. In many cases, basic haematology and biochemistry screens will also be useful prior to referral and, in the case of house-training problems and indoormarking behaviours in cats, urinalysis should be carried out before a behavioural referral is sought. In order to assist the veterinary surgeon in referring behaviour cases, the Companion Animal Behaviour Therapy Study Group has produced a printed referral form, which has been compiled in consultation with the Royal College of Veterinary Surgeons. This form provides space for all the essential information required in behavioural referrals and encourages a more systematic approach to the referral process. A copy is available in Appendix 1, and an electronic version may be downloaded from http://www.cabtsg.org.
Making the link with disease One of the most important roles of veterinary involvement in the workup of individual behavioural cases is the exclusion of potential links between systemic disease and behavioural symptoms. Providing suitable medical care for the patient exhibiting behavioural symptoms is the first step in providing a behavioural service, and knowledge of the medical differential diagnoses for the commonly presented behavioural symptoms enables the practice to investigate those symptoms in the most comprehensive way. Details of medical conditions that present with behavioural symptoms can be found in mainstream veterinary medicine textbooks, and examples of medical differentials will be highlighted in the relevant sections of this book. When investigating a behavioural case, it is important to obtain a thorough medical history, together with the results of a full physical examination. If a medical condition is suspected, it may be necessary to obtain further information such as the result of a basic neurological examination or the results of additional tests, including biochemistry, haematology, urinalysis and, sometimes, radiography (Box 1.9). More specialised tests such as electrocardiograph (ECG), electroencephalograph (EEG), magnetic resonance imaging (MRI), computed tomography (CT) scanning or cerebrospinal fluid (CSF) analysis may be required but are most likely to be requested following behavioural consultation with a veterinary behaviourist rather than carried out prior to referral (Box 1.10). Although medical differentials should be considered in any behavioural case, those situations in which a medical workup is of specific relevance are as follows: 1. Those involving a change in the personality of the animal, with the onset of aggression or the development of a generally irritable disposition.
Providing a practical behavioural service
Box 1.9 Screening profile for behavioural disorders ● ● ●
●
●
History and clinical examination Basic neurological examination Haematology, to include: PCV, white blood cell count, cell morphology Biochemistry, to include: urea, creatinine, total protein, albumin, bilirubin, bile acids, cholesterol, glucose, ammonia, ALT, AST, ALK, BSP retention, calcium, sodium, potassium, thyroxine, thyroid-stimulating hormone (thyrotropin) stimulation test Urinalysis, to include: blood, protein, SG, pH, bilirubin, bacterial culture and examination for crystals
Box 1.11 Potential medical causes of inappropriate, abnormal or unacceptable behaviour ● ● ● ● ● ● ● ● ● ● ● ● ●
2. Those involving symptoms related to urinary or gastrointestinal tract function. 3. Those involving dermatological symptoms.
In situations where the appearance of behavioural symptoms does not seem to coincide with any external factors (such as changes in social or physical environment or alterations in the relationship with the owner), where the owner reports the behaviour to be unpredictable and inconsistent, and where the development of the behaviour does not appear to be consistent with the theory of learning, it is especially important to consider medical differentials and provide a thorough medical workup of the case (Box 1.11).
Box 1.10 Additional tests as required ●
● ● ● ●
● ● ● ● ● ● ● ● ● ● ●
● ●
Cortisol/adrenocorticotropic hormone (ACTH) stimulation test Radiography Assay of sex hormones Skin scrapings and/or biopsies Cultures – swabs or faecal material for bacterial culture, hair samples for fungal culture Myelography Ultrasound/CT/MRI scanning CSF analysis Toxin assays Hearing tests Coomb’s test/antinuclear antibody (ANA)/LE cells ECG Malabsorption tests/TLI Allergy tests/exclusion diets Rectal examination Microscopic examination of urine for neoplastic cells or crystals Water deprivation and urine SG Parasitic egg counts
● ● ●
Cardiovascular disease Congenital/inherited conditions Degenerative conditions Gastrointestinal disease Hormonal disorders Immune/inflammatory conditions Infectious disease Metabolic disease Neoplasia Neurological disorders Nutritional disorders Orthopaedic conditions Pain Toxic conditions Trauma Urogenital disorders
Offering options The individual nature of behavioural problems not only accentuates the importance of accurate history-taking but also necessitates the careful tailoring of treatment plans to the specific needs of both the animal and its owners. There may be more than one possible approach to the problem and factors such as the severity of the problem, the owner’s feelings toward the animal, and their motivation to put any advice into practice, will all need to be considered. The necessary outlay for the owners in terms of money and commitment will also need to be balanced against a realistic prognosis.
Guidelines to dealing with behavioural problems and offering behavioural advice 1. There are no magic injections available for behavioural problems and owners need to be aware of the long-term nature of treatment regimes. Unrealistic expectations will lead to frustration and will rapidly decrease the level of owner motivation that is so crucial to the potential success of treatment. 2. There can be no guarantees since we are always dealing with individual living creatures, each of whom can react differently in any given situation. As Robert Holmes, veterinary behaviourist in Australia, has said, ‘Euthanasia is the only way to guarantee that a behaviour will stop’. 3. When dealing with behavioural issues it is essential not to apportion blame but rather to establish the cause, or causes, of the problem by careful questioning of the owners and observation of the animal.
13
14
PRACTICE TIPS
4. It is important to make the client aware of their own role in the modification of their pet’s behaviour and to emphasise that success depends on cooperation between themselves and the behaviour counsellor. The counsellor will, hopefully, be able to reach an accurate diagnosis and offer appropriate treatment regimes but it is up to the owner to put the treatment into practice and to keep in touch with the counsellor afterwards to assess progress. 5. Behavioural consultations are always substantially longer than their medical counterparts and hence they will also be correspondingly more expensive. However, the comparison between a clinical consultation and a behavioural consultation is unrealistic. It is more accurate to compare the behavioural consultation with a thorough workup of a complicated medical condition. The difference is that the workup in the case of a dermatological or orthopaedic condition takes place away from the owner while the animal is hospitalised for the day and is in the form of skin scrapes and X-rays. Behavioural workups take place in the presence of the client and take the form of in-depth discussion since the client holds the majority of the information that is necessary to reach a diagnosis.
All part of the service Preventive treatment and behavioural therapy have a very important place in veterinary practice and by increasing the awareness of behaviour problems within the practice
and working closely with behaviourists where necessary, it is possible to offer both patients and clients an excellent service in this field (Box 1.12). The benefits of doing so are enormous for pets and their owners and, indeed, for veterinary practices and their staff.
Box 1.12 practice ● ●
● ●
●
●
●
●
● ●
●
Promoting a behavioural service in veterinary
Talk about behaviour during routine consultations. Display posters in the waiting room advertising the behavioural service. Stock behaviour-related merchandise in the practice. Put booklets and magazines with a behavioural message on the tables in the waiting room. Play videos in the waiting room area that not only impart some information about behaviour but also to inform clients that behaviour is taken seriously in your practice. Pick up on clients’ comments, either over the telephone or whilst popping in to buy dog food, and take every opportunity to discuss behaviour. Organise talks at your local school – children are very effective at getting the message across to their parents. Use practice newsletters and client evenings of talks and seminars to make clients aware of behavioural topics. Run puppy parties and kitten information evenings. Arrange referrals to someone with a specific interest in behaviour. Offer behavioural consultations at the practice.
15
Chapter 2
Running puppy classes and kitten information evenings
CHAPTER CONTENTS Introduction 15 Puppy parties 15 Cost of providing puppy parties 16 Puppy socialisation classes 16 Potential pitfalls of puppy classes 17 Establishing links with trainers 18 Kitten evenings 19
INTRODUCTION One very practical way in which veterinary practices can be involved in preventive behavioural medicine is through the provision of puppy parties, puppy classes and kitten information evenings. The idea behind these ventures is that owners of new puppies and kittens are encouraged to come to the practice for specific sessions during which the major behavioural principles can be introduced and explained, the client and patient can familiarise themselves with the practice, and the practice can bring to the attention of their clients the many services that they have to offer.
PUPPY PARTIES Puppy parties are the simplest version of these client and patient-centred events and are the easiest to provide. They are one-off events which are usually held on one evening a month and are intended as a foretaste of the more structured puppy socialisation classes. Puppies usually attend ‘parties’ at between 9 and 12 weeks of age and up to eight puppies can usually be accommodated at each party. Since the puppies are between their first and second vaccinations, it is important to prepare the room adequately by disinfecting the area and to ensure that owners realise the importance of keeping poorly puppies at home. If a puppy is noticeably off-colour it is not sensible to bring it along and no puppy should attend a party on the same day as its vaccination. Puppies only attend one party and they are sent home with a goody bag packed full of information about the practice and the services that are available. These goody bags can also contain information about important issues such as insurance, but it is important for practices to scan the small print on the policies that they are recommending and advise clients to obtain the most comprehensive cover that they can afford. Edible treats for the puppy can also be included but be careful to ensure that the treats you provide do not, in any way, undermine or contradict your previous advice! The party will usually last for approximately 1 to 2 hours and it is common practice to ensure that it is free to the
16
PRACTICE TIPS
clients. The practice provides safe, suitable toys and tiny titbits for the puppies and often will provide drinks and light refreshments for the owners. All the family are invited and it is useful if children are encouraged to attend since the presence of a wide range of age-groups will help to provide valuable socialisation for the puppies. However, it is important to remember that 2 hours can be a long time for children to concentrate and the provision of some form of child-orientated activity, such as a colouring table or reading corner, is worthwhile. In the limited time that is available at puppy parties it is important to prioritise the information that is given and to emphasise the fun element of the evening. The idea is for owners and puppies to have a pleasant evening within the veterinary practice premises, to meet staff in a relaxed and informal manner and to teach some basic behavioural principles which will put the owner on the right road in their relationship with their dog. There is no set format for these evenings and practices need to develop a plan that works for them, but dividing the evening up into three sessions can be a useful way of ensuring that the important points are covered. 1. An informal introduction. 2. An educational section. 3. A practical session involving introducing the puppies to the consulting room.
During the informal introduction owners should be encouraged to introduce themselves to the other puppies in the group and a game of ‘pass the puppy’ can certainly help to break the ice. Interaction between the puppies can also take place in this session and practice staff need to be on hand to supervise this ‘playtime’ and ensure that it is beneficial for all of the puppies that are present. If a very nervous puppy has an aversive experience during a puppy party, it can do more harm than good so identification of strong boisterous individuals and shy timid pups should be done as the clients enter the premises at the start of the evening and, if necessary, the release of puppies for ‘playtime’ should be staggered. During the informal play session, it is important to take the opportunity to teach owners the importance of playing the right games with their puppies and of ensuring that interaction with other dogs is always under their control. During the educational section of the evening there are a variety of topics which practices may wish to discuss. Time is limited so it is important to make sure that the most important points are emphasised and, if necessary, other information can be covered in handouts which are included in the goody bag which every puppy gets to take home. Possible topics to include in the educational section of the puppy party include: ● ● ● ●
prevention of common behaviour problems neutering parasite control vaccination
● ●
nutrition insurance
In the third part of the evening the individual puppies are taken into the consulting rooms and introduced to the veterinary surgeon or veterinary nurse who offers the puppy titbits as it is standing on the examination table. The aim is to form pleasant associations with the consulting room and make consultations in the future far less traumatic for pets and their owners, as well as for the veterinary surgeon! While each puppy is being given its personal introduction to the examination table, the veterinary nurses can be giving the other puppy owners some more information about health issues or practice facilities. While the owners are in the consulting room the veterinary surgeon or nurse can teach them how to give their pet a very basic health examination and can emphasise the importance of training their puppy to accept daily inspections of its feet, teeth, eyes and ears. This early training is not only beneficial in teaching puppies to accept veterinary clinical examinations but is also helpful in ensuring that the administration of first-aid will not be a problem should it ever become necessary.
Cost of providing puppy parties Some practices are reluctant to consider providing puppy parties because of the costs involved but it is worth remembering that the benefits of puppy parties can be seen on three fronts, with owners, pets and practice staff reaping the benefits of this early investment (Box 2.1). Clients value the opportunity to build a stronger relationship with the practice and to receive valuable advice about how to care for their pets. Practices gain a chance to inform clients of the many services that they have to offer and to educate their clients to take advantage of them. They also have an opportunity to lay good foundations in terms of client interactions with their pets and to pave the way toward better-behaved animals in their consulting rooms. Pets in turn benefit from better education and training from their owners, from increased opportunities to socialise with people and other dogs and from the chance to form positive associations with the veterinary practice environment and staff. In cases where practices are reluctant to cover the entire costs of these evenings, sponsorship is often a viable alternative and many companies will welcome the opportunity to introduce their products to receptive new puppy owners. In return for sponsorship, the company will be able to distribute literature to clients and to increase the profile of their name in the minds of new owners.
PUPPY SOCIALISATION CLASSES Although puppy parties are a valuable addition to the services that practices have to offer, they are not long enough to allow in-depth discussion of behavioural or health-related
Running puppy classes and kitten information evenings
Box 2.1 Benefits of providing puppy parties within the practice
Pets gain: ●
●
●
●
an opportunity to socialise with other people and other dogs the chance to go to the veterinary practice for a positive experience an opportunity to meet practice staff in a positive atmosphere an increase in the level of their owner’s understanding of their needs.
Practice staff gain: ●
● ●
the chance to inform clients of the varied practice facilities and services the opportunity to form closer relationships with clients an improvement in the standard of behaviour of patients in the consulting room.
Owners gain: ● ●
●
●
the opportunity to meet with other puppy owners the chance to discuss their concerns with veterinary practice staff valuable education about their pet’s behavioural and physical needs a better behaved pet who is a pleasure to own
issues and owners are advised to follow on with more socialisation and training by enrolling their puppies in a puppy socialisation class. In contrast to the puppy party, the socialisation class spans 4 to 6 weeks and takes the form of a course in early training, appropriate socialisation, and responsible pet ownership. There is a greater opportunity to provide the puppies with exposure to novelty in the form of play equipment, different domestic items brought from the owners’ homes and people dressed differently so that the puppies have experienced a really wide range of people, including children and the elderly (Fig. 2.1) Some veterinary practices have the facilities and the manpower to set up puppy classes at their own premises. This is ideal since it offers extended opportunities to educate owners and improve client relations and the puppy class in a veterinary context can include education on health-related matters as well as behaviour. Unfortunately, however, it is simply not possible for all practices to provide this service and, in these situations, it is important for practice staff to make it a priority to find out about the nearest puppy socialisation classes that are available and to encourage clients to take their puppies along. Those classes that are held at training schools rather
Figure 2.1 The range of novel stimuli encountered by puppies at socialisation classes may be expanded by the use of costumes and props.
than veterinary practices will obviously be more focused on behaviour and training but, provided that they are well run, they offer a vital opportunity for puppies to socialise with people and other dogs and to set owners on the right path in terms of training techniques. In some areas it may be necessary for owners to travel considerable distances to get to a puppy class but an investment in time and money in order to attend will more than pay for itself if the result is a well-mannered dog who is a pleasure to own for the next 15 years. By giving owners the information about puppy classes and telling them how to find one, the veterinary practice is providing as much of a behavioural service as one that has the facilities to offer classes on its own premises. See Figure 2.2 for guidelines for the format of puppy socialisation classes.
Potential pitfalls of puppy classes Veterinary practices are in an ideal position to explain the potential benefits of puppy classes and their recommendation will be seriously considered by any new owners who
17
18
PRACTICE TIPS
Suggested format for a 4-week puppy socialization class within a veterinary practice. At each session (excluding week one) there is the opportunity for a session of controlled play, a short ‘training session’ and introduction to the consulting room. Each session ends with a short question session. WEEK ONE Owners come to the practice without their puppies! This gives the opportunity for owners to concentrate on the information that is being given without being distracted by their puppies Videos can be used to educate owners about canine communication and pack structure The importance of socialisation and habituation is highlighted The aims of the puppy class are explained and any important questions answered WEEK TWO Puppies and owners are welcome Discuss basic principles of learning theory Introduce the concept of the use of a food lure and hand signals in teaching puppies to sit Discuss ways to overcome common problems such as play-biting and house-training Give information about diet and exercise WEEK THREE Introduction to basic veterinary examination to encourage acceptance of handling Introduce the concept of clicker training and use to teach ‘down’ command Discuss dental issues
Give information about identification and neutering WEEK FOUR Discuss need for routine vaccination and parasite control Teach basic first aid for dogs Discuss legal implications of dog ownership Explain the benefits of pet insurance
Figure 2.2 Suggested format for a 4-week puppy socialisation class within a veterinary practice.
are keen to do the very best for their new pet, so it is vital that the practice has first-hand knowledge and experience of the class before it starts to recommend that its clients attend. As with dog training classes, there are good and bad puppy classes and, whilst the advantages of socialisation classes are undoubted, the way in which those classes are run is crucial to their success. Socialisation and habituation are vitally important but they need to be carried out correctly if they are to be beneficial and inappropriate techniques can result in an experience which is totally counterproductive. For example, periods of off-lead socialisation need to be controlled and small numbers of puppies should be allowed to interact at a time. Free-for-alls with large numbers of puppies being let off to ‘enjoy themselves’ can do more harm than good. Instead, owners should stay in control and, periodically throughout the ‘playtime’, puppies should be called back to their owners in order to learn that human instruction is always more important than uncontrolled fun. The temperaments of the puppies present need to be taken into account and nervous and withdrawn individuals need to be given the opportunity to explore without being overwhelmed by others. Inappropriate experiences at this stage can lead to the development of behaviour problems, rather than their prevention and the products of unsuccessful puppy classes will often find their way into behavioural clinics later in life with problems relating to inappropriate communication with other dogs.
ESTABLISHING LINKS WITH TRAINERS It is well established that even the best programme of socialisation and habituation in early puppyhood needs to be maintained if it is to have lasting effects and, for owners who have attended appropriate puppy socialisation classes, it is important to follow this early education programme with ongoing and appropriate training. Basic obedience training is an important factor in maintaining a good dog–owner relationship and it has a strong role to play in the prevention of behavioural problems. Obviously, it is neither possible nor appropriate for veterinary surgeries to offer training classes at their premises, but owners will often look to veterinary practice staff for guidance as to which training school to select. Many practices do not wish to be seen to endorse any particular trainer, but the desire to remain impartial can lead to the practice of veterinary surgeries displaying the business cards of every training club in the area! This is not helpful to the clients and may even be detrimental to the animals. If telephone numbers have been obtained from a veterinary surgery most clients will assume that the training club is in some way approved by the practice and, especially for new dog owners who have nothing to compare, such recommendation is heavily relied upon. It does not take long for a member of the practice staff to visit the local training classes while they are in action and this gives them the opportunity to see what training methods are being employed. Inappropriate training techniques
Running puppy classes and kitten information evenings
can do immeasurable damage both in the short and the long term and, therefore, practices owe it to their clients to only suggest training classes that they know something about.
KITTEN EVENINGS Until recently the emphasis in terms of preventive behavioural medicine has been on the provision of adequate socialisation and habituation for puppies but, as the cat takes over the number one slot as the most popular companion animal, the importance of preparing kittens for life in a human context is also increasing. Many practices are now finding that they have a higher percentage of cats on their books than dogs and yet kitten owners often receive a fraction of the help and support that is on offer to puppy owners in terms of their pet’s behaviour (Fig. 2.3). There has been a lot of interest in the programme of Kitten Kindergarten, which has been pioneered in Australia by veterinary surgeon Dr Kersti Seksel and involves inviting kitten owners to bring their kittens to the veterinary hospital in order to attend two 1-hour classes held 1 week apart. Dr Seksel stresses that these classes are not simply feline versions of the puppy party since cats and dogs are two very distinct species and the methods used to train and socialise dogs cannot simply be transferred to the feline world. The aims of the classes according to Dr Seksel are to: ● ●
increase the knowledge of owners about cats have better behaved adult cats
● ●
prevent behaviour problems build a strong bond between the veterinary practice and the client.
In the Australian programme, the classes accommodate kittens of 12 to 14 weeks of age, with classes being limited to 3 to 6 kittens. Kittens older than 14 weeks are excluded as they may simply learn to fight rather than play, unless the classes are very well controlled. In the UK there has been some resistance to the provision of classes for kittens and their owners owing to concerns over the fact that the kitten’s socialisation period runs from 2 to 7 weeks of age and, therefore, the benefits of actual social interaction with other kittens during the class may be limited. Obviously, the limitations of vaccination mean that classes at an earlier age are not possible on health grounds and, therefore, a compromise has been established whereby owners of young kittens are invited to come along to the practice without their pets for a ‘kitten information evening’. These evenings can be highly successful as a public relations exercise and they offer the opportunity for practice staff to pass on crucial information about kitten development and health care. If the practice has an adult cat or demonstration kitten that can be on site for the evening, it is possible to demonstrate the various training techniques and handling skills and then encourage owners to go home and practice with their own pet. Until the contentious issues regarding face-to-face feline socialisation classes are explored in more detail the ‘kitten evening’ is the perfect compromise and illustrates to clients that cats are valued by the practice as much as dogs (Fig. 2.3).
Suggested format for a 2-week course of kitten information evenings within a veterinary practice. WEEK ONE Discussion about the origins of the cat and the history of its relationship with man Explanation of the social structure of feline society Overview of feline communication systems Explanation of the importance of play in feline development and the selection of appropriate toys Discussion about dental care and nutrition
WEEK TWO Introduction to the basics of learning theory, illustrated by teaching the demonstration cat to give a paw! Discussion about the appropriate use of rewards and discipline Explanation of the importance of environmental enrichment, especially for totally indoor cats Discussion about routine vaccination and parasite control Explanation of the benefits of pet insurance
Figure 2.3 Suggested format for a 2-week course of kitten information evenings within a veterinary practice.
19
23
Chapter 3
An overview of canine social behaviour and communication
CHAPTER CONTENTS Introduction 23 Wolf social behaviour 23 Dog social behaviour 24 Communication 24 Auditory communication 24 Visual communication 25 Olfactory communication 27
INTRODUCTION In order to understand the way in which dogs relate to their owners, to people outside the family, to other household pets and to dogs that they meet out on walks, it is essential to have a basic knowledge of canine social behaviour and communication. It is generally accepted that the domestic dog is descended from the wolf, although the process of domestication is believed to have occurred in more than one location and despite the time that has elapsed and the significant level of selective breeding that has occurred, the dog still shows many of the behaviour patterns that are exhibited by its ancestor species.
WOLF SOCIAL BEHAVIOUR The wolf is the largest and the most social of all canids. Characteristically, wolves live in a pack of related individuals but, in common with most canids, they display significant flexibility in their social organisation depending upon the availability of food. Under normal circumstances only one male and one female within the pack breed at one time and these individuals are referred to as the ‘alpha’ or topranking pair. Their role is to ensure the continuation of the pack through breeding and in order to achieve this, they provide leadership for the group, control access to shared resources and suppress breeding in other pack members. The remaining lower-ranking members of the pack assist in the rearing of young and all members of the group cooperate in hunting in order to increase the size and range of prey that can be caught. Individuals only remain associated with the pack as long as it is advantageous to them. When food becomes plentiful during the summer months the members of the pack often disperse and then reunite in the autumn when it becomes necessary to hunt larger prey. The individuals who obtain the most personal benefit from their pack membership are the alpha male and alpha female since their fellow pack members help to feed and protect their cubs, so increasing the cub survival rate and the chances of the alpha pair successfully passing on their genetic material into the next generation. The nature of
24
BASIC TOOLS IN BEHAVIOURAL MEDICINE
aggression within the pack reflects this fact and the alpha female in particular is very aggressive towards other females during the mating season. Studies have shown that through persistent attacks they will cause the cubs being carried by a lower-ranking female in the group to be miscarried. The alpha male, contrastingly, is most aggressive towards strangers that attempt to associate with the pack and this is presumably to ensure that no other unrelated wolf sires cubs that he will then help to raise. Interestingly, the lower-ranking members of the group tend to be sociable to other wolves, both inside and outside the pack, and to demonstrate an inherent need for social interaction.
DOG SOCIAL BEHAVIOUR Although many similarities are seen between the natural behaviour of the wolf and the behaviour of the domestic dog, it is important to remember that the close association between the dog and man has had a profound effect on canine social behaviour and communication. The fact that most dogs are kept within a predominantly humanorientated environment and have only brief opportunities to interact with other members of their own species in a social context means that few dogs have a chance to set up stable social relationships free from human influence. Studies which have investigated the effects of domestication on the social behaviour of the dog have primarily focussed on feral and free-roaming dogs and have shown that packs are formed in which some individuals are able to gain plenty of access to resources over others. This supports the concept of relative status within the group and the existence of some form of dominance hierarchy. Unlike wolf packs, however, little cooperative hunting and rearing of the young is seen and communication between individuals appears to be more limited than within wolf packs. Nonetheless, many of the same signals have been demonstrated in feral or free-roaming dogs and more research is required to investigate their significance.
COMMUNICATION Within a social system, effective communication is essential for the formation and maintenance of relationships and dogs, like wolves, have three main methods of communication. These involve the use of auditory, visual and olfactory signalling and a basic awareness of the significance of these signals can hold the key to understanding many of the commonly presented behavioural problems in veterinary practice.
Auditory communication Auditory signals are used to communicate in a variety of different contexts over a range of distances. Studies have
described a range of signals given by dogs that have also been recorded in wolves. Sounds include grunts, whines, yelps, screams, coughing, tooth snapping, growling and barking. The message conveyed by these sounds seems to vary according to the context (Fig. 3.1). The information conveyed by the vocalisation is supplemented with information about the whereabouts of the messenger and vocal signalling can take on specific significance when vision is impaired, for example, by thick vegetation or at night. One of the most striking differences in terms of auditory signalling in dogs and wolves is in the frequency of barking and levels of this particular form of canine communication are believed to be higher in the domestic dog than in any other canid. Certainly, adult wolves rarely bark unless they are doing so to alert the rest of the pack to some potential danger or offer some form of challenge to a wolf from outside of the social group. It is this second function of defending the social group and calling attention to potential threats that is believed to have been selected for in the breeding of domestic dogs, but this is not the whole story and barking is also believed to have been advantageous in the guiding of human hunters during the pursuit of prey. Barking is also believed to be more frequent in juvenile canids than in adults and the selection of juvenile characteristics in dogs through the process of neotenisation is believed to have included selection for more frequent barking. As this has happened, the function of the bark has
SOUND
BEHAVIOUR
Whimper/whine
Appeasement Defence Greeting Pain Attention-seeking Play Defence Warning General Excitement Anticipation
Teeth-chatter
Grunt
Greeting Sign of contentment
Growl
Defence warning Threat/play signal
Bark
Defence Play Greeting Call for attention Warning
Howl
Call for attention To announce presence
Figure 3.1 Meanings of different canine vocalisations. (Adapted from J. Serpell 1995 The domestic dog. Cambridge University Press, Cambridge, UK)
An overview of canine social behaviour and communication
altered to the point where it now serves no function except to attract attention to the animal and any visual signals it may be displaying. It is certainly not possible to gain any additional information about an individual as a result of its bark, other than the fact that it is in a raised state of arousal.
Visual communication Within and between wolf packs visual communication is central to conveying information about social status and emotional state and is particularly useful for controlling aggression during social interactions. Whole body postures, together with facial expressions and tail postures, are used to convey the likelihood of conflict and to offer the opponent an opportunity to signal that confrontation is unnecessary (Figs. 3.2–3.5). In wolf society, a high-ranking individual is characterised by an upright, high body posture with head, tail and ears held erect, while less confident, lower-ranking individuals adopt a lower, more crouched, body posture with tail and ears held low and close to the body. The impression created by the higher-ranking individual is one
Figure 3.3 A hesitant initial greeting between two dogs.
Figure 3.2 Labrador retriever showing posture typical of fear. This posture decreases the animal’s apparent size in order to reduce the threat it poses. Tail is tucked under and head is carried low.
25
26
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Figure 3.4 The dog on the right is more bold, showing a more upright body posture and higher tail carriage.
Figure 3.5 Aggressive facial postures in the dog. To the left is a typically dominant facial posture, with increasing subordinate or fearful posture displayed rightwards. Note the ear position, facial tension, eye closure, and shift from front teeth being displayed to side teeth being displayed.
of confidence and control while the lower-ranking animal uses posture to make it look smaller and less significant than it really is. Signals of aggression and fear, or appeasement, are used to exaggerate these basic postures and to avoid direct confrontation but as the distance between the individuals lessens, so the need for more honest signalling is seen. A confident wolf that is intending to use aggression to resolve the situation, if necessary, will use postural signals to make its body appear larger. These might include raising the hackles and tail, leaning forward toward the animal which is being threatened and staring intently, baring its teeth,
curling its lips and flicking its tongue in and out to draw attention to the oral weaponry on display. As the aggressive encounter continues, the aggressor will move closer to its opponent and show its strength by attempting to physically push or displace the other, but this will not occur until some subtle communication on the part of the lower ranking individual has taken place. A fearful wolf that is trying to stop any further escalation in aggression will attempt to do so by decreasing its perceived physical size through cringing, tucking its tail between its legs and holding its head down and demonstrating its desire to appease by avoiding eye contact and displaying a submissive grin in
An overview of canine social behaviour and communication
which the corners of the mouth are pulled back. If the aggressor fails to respond to these signals and the threat of out-and-out physical confrontation continues, these fearful individuals will roll on their back and display the anogenital area as a sign that they are giving up any attempt at defence. This passive submission is sometimes accompanied by urination. A more confident subordinate will adopt a slightly different strategy and engage in active submission whereby it approaches the aggressor with its body held low and its tail wagging. It will often attempt to lick and nuzzle the face of the opponent in a parallel to the food-begging gestures shown by cubs and will respond to attempts to physically displace it. In view of the fact that outright physical confrontation runs the risk of injury to either party, the wolf has developed an elaborate communication system and when two wolves meet one another and both are interested in gaining the same resource, such as a piece of food, they will exchange a display of visual signals which are designed to avert conflict. Through the signals each is able to assess its likelihood of success in a physical fight. The signals that are first shown are usually ones that can be exchanged at a distance and the least aggressive of these signals is the stare. If an animal decides to proceed no further in its aggression it can end the conflict by looking away. As the competition progresses the signals escalate in intensity and the individuals move closer to one another, so increasing the chances of physical injury occurring. As the intensity of aggressive signalling increases, so too does the intensity of appeasement which is needed to stop the conflict and the postural signals become more and more exaggerated. The only circumstances in which overt damaging aggression will occur are when two animals are so well-matched that neither is able to determine which is physically stronger, or when both are equally motivated to fight in order to protect a resource of significant value. Another socially significant posture in wolves is the play-bow (see Figure 3.6 for an example in the domestic dog), which indicates a willingness to play. This is shown by the wolf lowering its fore-quarters whilst keeping its hind legs erect. Prior to this, the wolf may have made several exaggerated approaches to the individual it wishes to play with and have withdrawn rapidly while wagging its tail. Often the mouth is held open and exaggerated panting occurs. These behaviours are designed to ensure that there is a level of understanding between the individuals as they engage in play and to signal that any aggressive signals encountered during the impending interaction are not to be taken seriously. The degree to which a domestic dog uses visual signalling depends to a large extent on the breed since selective breeding for particular colourings and certain morphological characters, such as drooping ears, long fur, heavy jowls and short tails, have made it difficult for some breeds to accurately signal their emotional state. An Old English Sheepdog, for example, is unable to significantly raise its
Figure 3.6 Example of the typical ‘play bow’ behaviour between two puppies.
hackles, has great difficulty in signalling with its tail and ears and finds it impossible to use eye contact effectively. For such breeds the only type of aggressive signals they can display are the more intense ones and, since this limits their options for warning other dogs off, it becomes more likely that they may get involved in physical fights. Studies done at the University of Southampton have indicated that the range of aggressive and submissive behaviours shown by a breed is closely correlated to their physical appearance. For example, breeds that resemble juvenile or neonatal wolves more than adults, such as the Pekingese, show fewer and more intense agonistic signals than more adult wolf-like breeds such as Huskies. Interestingly, it is the breeds of more juvenile appearance which are more likely to interact with other dogs in a juvenile manner and, since juvenile interactions are often more physical (and hence aggressive), this explains why many of the small companion breeds have a reputation for being aggressive.
Olfactory communication Scent signals are often overlooked by humans since they are of very little significance in their own social communications but wolves and dogs show a similar ability to communicate via smells and odours and their importance should not be underestimated.
27
28
BASIC TOOLS IN BEHAVIOURAL MEDICINE
In the canine world, the deposition of faeces, urine, and anal sac secretions around the animal’s environment is an important aspect of social communication and the distinctive body odour of individuals is believed to convey important information about a number of issues, including identity, sex and sexual receptiveness. In addition, a combination of scent signals are used to indicate information about ownership of an area, the frequency of its use and how recently an animal has passed through it. One of the major advantages of olfactory signalling over other forms of communication is the fact that the messages remain in the environment for a long time and can signal even when the depositor is not present. This is particularly useful when encounters between individuals are best avoided and when animals are entering into a territory for the first time and run the risk of meeting with a hostile reception.
urine that is rich in social odours that indicate sexual receptivity and they increase their frequency of urination during oestrus to spread the odour-rich urine over a wider area so as to increase their chances of attracting a mate. It is not only the odour of urine marks that conveys important information between wolves. Location is also believed to be significant. Alpha males and females cock their leg when they urinate and information about status is believed to be conveyed in the relative positioning of urine signals, with higher-ranking individuals depositing their marks higher off the ground than lower-ranking members of the pack. In dogs, status seems to affect the method of leaving scent marks less significantly, but males will generally deposit urine by raising a leg in a cocking motion while females more commonly squat to urinate. Prominent objects are usually selected to urinate on, presumably because they act as visual cues to encourage investigation of the presence of any olfactory marks.
Faeces Faeces do appear to have a particular significance as a form of scent communication in wolves, with pack members leaving their faeces where they are likely to be located by other wolves. They are believed to act as a marker of residency without the need for the territory owners to be present and it is certainly true that scent marks are deposited at greater densities along the edges of territories and especially if a foreign scent is encountered. In contrast, dogs show much less interest in faeces, and defecate most commonly when off the lead and when the owner is not present. This is possibly due to the inhibitory effect of training methods used during the house-training process but there is little evidence that faeces play much of a role in olfactory communication in dogs apart from notifying an individual, by the freshness of the dung, that another dog has passed by.
Urine Unlike faeces, urine appears to be equally important to both wolves and dogs as a method of communication and urine marks are eagerly investigated by both species. The strength of the odour of urine marks decay over time as volatile chemicals in the urine evaporate and this enables animals to use these signals to determine how recently a dog has passed by and left a mark. Regular overmarking of scent marks indicates to others that an individual wolf or dog uses the area frequently. In addition to supplying dogs with temporal information, urine marks can also give information about sex and sexual receptivity and status. In oestrus, females produce
Anal sacs All canids possess anal sacs which are paired reservoirs either side of the anus that produce apocrine gland secretions. The contents of the anal sacs are discharged during defecation and variation in the composition is believed to reflect changes in daily diet. The significance of the anal gland secretions in canine communication is the subject of some debate, but studies have shown that individuals differ in the chemical constituents of their anal sac secretions and they are therefore thought to be important in individual recognition. In wolves, the highest-ranking individuals within a pack present their anogenital area for inspection during greeting rituals but subordinates cover it with their tail and try to avoid being sniffed. Such behaviour appears to be mimicked when two strange dogs encounter each other and in many cases both dogs seem to behave like subordinate wolves, eager to collect scent information but unwilling to give any away.
General odours These are produced by a variety of skin glands situated around the head, anal region, upper surface of the base of the tail and the perineum. These glands are thought to provide each dog and wolf with an individual odour and to be important in the recognition of members of the same social group. Detection of these odours is therefore important in greeting rituals and this explains why dogs usually engage in head-to-head or head-to-rear end communication when they first meet.
29
Chapter 4
An overview of feline social behaviour and communication
CHAPTER CONTENTS Introduction 29 Social structure and behaviours 29 Allogrooming 30 Allorubbing 30 Communication channels 30 Olfactory communication 31 Vocal communication 32 Body language 33
INTRODUCTION Many of the behaviour problems commonly presented in the domestic cat arise as a consequence of the constraints of domestic life on an animal that is not truly domesticated and from human misinterpretations of natural feline behaviours. It is therefore important for anyone dealing with the prevention and treatment of these problems to have an understanding of feline social structure and of the communication systems that are central to the maintenance of an effective feline society. In the wild, cats live together in groups of related individuals and they have very little contact with outsiders. They hunt alone and when they are out on hunting expeditions they aim to limit their interaction with other felines. For these reasons, most feline language is designed to increase distance between individuals and those signals that are intended to encourage interaction are usually reserved for members of the same social group.
SOCIAL STRUCTURE AND BEHAVIOURS Feline society is matriarchal in nature, with related females living together in highly cooperative groups, sharing the rearing of each other’s offspring and defending each other from potential intruders. In order for a society to function it is necessary for interactive behaviour patterns to signal group identity and structure and in many species, including dog and man, these patterns are related to some kind of hierarchical organisation within which an individual’s position can be determined by observation of its interactions with other members of its group. Some of the most significant of these patterns are those indicating submission but within the feline world no such pattern has been identified and their reaction to hostile interactions is one of defence rather than submission. Without the presence of a hierarchical framework, the stability of social groups relies on the presence of cooperative behaviours and in the case of feline society, it appears that the affiliative social behaviours of allogrooming and allorubbing hold the key to social harmony. These mutual behaviours appear to be
30
BASIC TOOLS IN BEHAVIOURAL MEDICINE
important in confirming the social relationship between individuals and in establishing and maintaining a common scent profile within the social group.
Allogrooming In the case of allogrooming the behaviour appears to be reciprocal in nature. It often coincides with resting and therefore it is most commonly seen between cats that rest together (Fig. 4.1). In addition to its role in reinforcing bonds between closely related individuals and providing stability within the social group, allogrooming is also believed to facilitate reconciliation between two members of a social group that have recently been antagonistic towards one another.
Allorubbing Allorubbing is believed to act not only as a means of mixing scents between individuals (Fig. 4.2) but also as a means of exchanging tactile signals and, unlike allogrooming, this behaviour appears to be asymmetrical in nature with one individual noticeably taking the initiative in the interaction. Indeed, it is often possible to detect a pattern of rubbing within a social grouping which suggests some hierarchical significance to this behaviour as it progresses from kittens, which rub frequently on all cats except adult males, through juveniles, which rub on adult females, to the adult females themselves, which rub on each other and, occasionally, on adult males. Of all of the feline social behaviours rubbing is the one with most significance in the cat–owner relationship and when cats rub on their owner’s legs it is usually interpreted as a sign of affection. However, observation of the behaviour between cats suggests that it is used when the relationship is slightly one-sided and is usually initiated by the weaker individual. Cats do not live in a structured hierarchy but they do have respect for one another and, while rubbing may not be classed as a submissive behaviour, it
Figure 4.2 Allorubbing during a greeting between two cats.
does appear to be important as a means of acknowledging status. Immediately before a rubbing interaction the initiator will raise its tail as it approaches the other cat and this gesture appears to be a significant signal of intent to rub. What happens next appears to depend on the reaction of the recipient and in situations where it responds with a raised tail signal, the rubbing appears to continue as a mutual and simultaneous behaviour whereas recipients that do not use a tail-up response will either rub after the initiator has rubbed, or not at all. Within the context of cat–owner interactions, rubbing appears to be a means of acknowledging owner status, confirming the relationship between the two species and also exchanging scent signals in order to establish a common scent which can then be used to identify members of the same social group and reassure individuals that they belong. It is also a behaviour that is reinforced in most domestic cats by the response of the owners and for many individuals it has been conditioned as a behaviour which results in the human response of opening another tin of cat food!
COMMUNICATION CHANNELS
Figure 4.1 Allogrooming
In common with canine communication, the methods that cats use to convey information fall into the three main categories of visual, vocal and olfactory signalling, but transferring knowledge of dog communication into the feline world simply does not work and trying to do so can lead to unnecessary confrontation. Feline visual signals are often subtle in nature and can be difficult to interpret whereas olfactory communication, which plays such a vital role in feline society, is simply a mystery to human beings. Vocalisation is a highly conditioned form of communication in the domestic cat and, while information is available about the function of the major vocal signals, it should be remembered that some of the signals used by individual
An overview of feline social behaviour and communication
cats within households are learned responses to the interactions of those around them. These signals are used by cats to initiate social interaction with owners and to direct people to perform certain tasks, such as feeding the cat or opening doors and windows to allow access to outdoors.
Commercially produced analogues of the F3 (Feliway) and F4 (Felifriend) fractions are used in the prevention and treatment of certain behavioural problems in cats.
Olfactory communication
When cats scratch they are engaging in a very natural and complex behaviour which has both functional and marking components. As the front claws are pulled downward in that familiar stropping action, the blunted outer claw sheath is removed and a glistening new claw is revealed. In addition to preparing the claws for hunting, scratching also enables cats to stretch their front legs, shoulders and back and exercise the muscles and tendons involved in claw protraction, thereby ensuring swift action when prey is detected. Although the maintenance of hunting prowess is a priority for cats, scratching is also an important behaviour in terms of communication and the glands between the pads of the cat’s feet deposit a special scent signal as the cat scratches. This scent message is in addition to a visual signal: the vertical scratch marks which are left in the surface.
Although cats are social creatures, they retain an element of independence and when it comes to the process of hunting they act alone. Important consequences of this solitary hunter status are the need to maintain personal fitness, to avoid unnecessary conflict and risk of injury and to secure and protect a hunting territory. In order to fulfil these objectives the cat needs to be able to communicate with other cats from a distance and to signal its occupancy of its territory without risking direct physical interaction with total strangers. It is for this reason that olfactory communication, which provides a signal that lasts over a period of time and gives a message to other cats remotely, is so important in the feline world. Indeed, the cat is highly adapted to send and receive scent signals through the presence of special scentproducing glands in various locations around the body and through the use of the Jacobson’s or vomeronasal organ to receive and interpret scent messages. The major areas of scent production are the face, the flanks and the tail base but cats also have glands on the paws, which deposit scent signals during the process of scratching. The scent that the individual produces is believed to be unique and helps to identify it to other cats both within its social group and in the wider community. It is also important to realise that scent signals can be used as a means of self-directed communication and can be deposited as signals to the depositor regarding the familiarity of the environment and the level of security that it offers. The depositing of scent signals, or marking behaviour, is therefore essential to feline communication and social behaviour and within the context of domestic cat behaviour it takes four main forms.
Rubbing In addition to the social behaviour of allorubbing, cats use the glands on the face, flank and tail base to mark items within their territory. They will rub their face along twigs and fence posts in the garden and along items such as shopping bags and new furniture that are brought into the house. Owners will often comment that their cat rubs its face along their shoes when they return home and this appears to be a reaction to the multitude of different scent signals that are carried on the surface of shoes. Although little is known about the behavioural significance of many of the social odours produced from the range of scent-producing glands on the cat’s skin, there has been extensive research into the constituents of some of the facial scent glands and the scents that are deposited during the act of facial rubbing seem to be highly correlated with the solicitation of social interaction and with familiarisation with the environment.
Scratching
Urine marking The use of urine as a marker is common practice in feline circles and the act of urine spraying is usually performed from a standing position. The name spraying comes from the very characteristic position that cats adopt as they back up against the scent post and squirt very small amounts of urine in a horizontal stream onto the vertical surface. They usually have their back slightly arched during the behaviour and will tread with their hind feet while the tip of their tail quivers (Fig. 4.3). Most cats appear to concentrate while they are depositing their signal and a vacant expression on the face is common. Although spraying is the most common form of urine marking, it is not the only one and some cats will mark with urine that they deposit from a squatting position. Whichever position they adopt, all cats engage in urine marking at some point in their lives and most do so on a very regular basis in their outdoor territory. This is not a behaviour that is limited to tomcats and cats of either sex will still urine-mark when they are neutered. One of the purposes of urine-marking as a form of communication in the outdoor environment is to operate a very elaborate timeshare system which ensures that the available territory is not overhunted. It also minimises the risk of unfamiliar individuals coming into contact and potential confrontation. Although spacing between cats appears to be one of the most important functions of feline marking behaviours, it is important to remember that urine marking has the opposite function when it is performed by entire males and females as a means of informing neighbouring cats that they are ready and available for mating. In this situation the urine of oestrous females appears to carry important information regarding her sexual status and level of receptivity and tomcats pay a great deal of attention to the marks of these females. It is this sexual component of spraying
31
32
BASIC TOOLS IN BEHAVIOURAL MEDICINE
to their fellow felines this is called middening. This behaviour is usually seen at the boundaries of the cat’s territory and piles of faeces which are found in exposed locations such as the middle of a well-mown lawn, the tops of fence posts and the ridges of roofs are more likely to have been deposited as deliberate markers than be the product of normal elimination behaviour.
Vocal communication
Figure 4.3 Typical spraying posture in the cat.
behaviour which is affected by neutering and, therefore, the likelihood of developing problems associated with this form of marking can be reduced by ensuring that cats of both sexes are neutered prepubertally. In many cases within the domestic environment, urine marks appear to act as a self-directed signal and a means of reassuring the cat that the territory is their own or of signalling that a particular location is associated with potential danger. Indeed, the locations of indoor spray marks are often those that are associated with something unpleasant, such as threat from outside cats. Spraying can also occur as a redirected activity when other forms of social interaction are frustrated, or even as a learnt attention-seeking activity to gain social contact with owners. It has also been reported as a passive manifestation of aggression in situations of social tension between cats in the same household.
Middening As well as using urine as a marker, cats can use their faeces to communicate with other cats and when they deposit faeces in deliberate locations in order to get a message across
Although cats do use vocalisation in order to communicate this is probably the form of feline communication that we know least about. Cats are generally considered to be at their most vocal while they are kittens and a lot of vocal signalling in the cat is associated with greeting and with social contact. There are thought to be at least 16 different distinct vocal signals but research is still being carried out into exactly what each of these signals means. The picture is also complicated by the fact that many cats use vocal signals that are unique to themselves; owners of more than one cat will often comment on the fact that they know which cat is approaching by the type of miaow. It is well-recognised that cats are very good at training their owners to respond to their vocal demands and the development of the individual noises is probably connected with the timing of the owner’s response. In general terms, cat sounds can be divided into three groups. The first includes those noises that are produced with the mouth open and gradually closing, in a similar way to our own speech, and examples include the miaow which is used in greeting and the female and male calling signals used during the mating process. Their aim is to incite social interaction and this group of sounds is associated with amicable encounters. In the second category there are sounds that are produced with the mouth closed and these include the purr and the trill or chirrup. The purr is a very characteristic feline sound and the situations in which it occurs are many and varied. The old myth that all purring cats are happy is easily dispelled when you listen to purring road traffic accident victims and cats that purr loudly as they are examined on the veterinary consultation table. This form of communication is commonly associated with mothers and kittens and certainly kittens do use the purr to communicate during nursing. However, it is also used in play and during social interactions with owners and it appears that the purr is either associated with periods of actual interaction between cats or with people or in situations where social contact is desired. The loud vocal signals that make up the third category are produced when the cat holds its mouth open in a fixed position and they have been called strained-intensity calls. Examples include the hiss, the spit, the growl and the snarl and their use is limited to situations of defence and aggression. One specific example of this sort of call is the pain shriek which is designed to startle an attacker into loosing
An overview of feline social behaviour and communication
its grip and anyone who has had to handle a cat against its will understands just why it is classed as a shriek!
Body language Sound and smell are obviously very important in the feline world of communication, but body language is also used to get messages across and it is important for those involved in dealing with feline behaviour problems to understand how cats use both their whole body posture and their facial expressions to communicate. As a result of its solitary predator role the cat needs to have very clear and unambiguous signals in order to prevent misunderstanding with the strangers it encounters when away from home. The lack of any pack structure means that an injured cat is very vulnerable and therefore most of the cat’s communication signals are designed to avoid conflict rather than incite it.
The position of the body and its readiness to flee from the situation give the best indications as to the intention of the cat and, although the facial signals are undoubtedly the most important in fine-tuning the cat’s message, it is the body posture that gives the first impression to an approaching cat (Fig. 4.4). Cats are renowned for bluffing their way out of conflict and raising the hairs along the back and on the tail is often combined with arching of the back and standing sideways on to a potential opponent in order to make the cat look twice its actual size. The theory is that a large cat will scare away any would-be attackers but in some situations the bluff fails and, when it does so, the cat will slowly retreat by moving sideways out of range. The slow movement is very important in order to prevent inciting the attacker to chase and the sideways movement allows the cat to keep its adversary in view, just in case there is a last minute change of tactic.
Figure 4.4 Whole body postures. In this grid of body postures aggression increases from left to right and fear from top to bottom. So the cat in the bottom right corner is the most aggressive and fearful. (Adapted from P Leyhausen 1979 Cat behaviour. Garland STMP Press, New York)
33
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Bluffing is not always considered an appropriate response and when cats are very frightened they will often shrink to the smallest possible dimensions and try to hide. It is in these situations that the feline maxim of ‘I can’t see you so you can’t see me’ really comes into play. In the end, all cats would prefer to avoid conflict if possible and this explains why flight is seen as such a desirable option when a cat finds itself in a situation where it feels threatened.
Less
Facial expressions Cats use the position and shape of the ears, the eyes and the position of the whiskers as rapid vehicles of communication and, although overall body posture gives important information, it is the face that is most useful in the finetuning of feline communication and is the most important part of the cat to watch for clues as to what it is going to do next (Fig. 4.5).
Aggression
Fear
34
More Figure 4.5 Facial postures. In this grid of facial postures aggression increases from left to right and fearfulness from top to bottom. (Adapted from P Leyhausen 1979 Cat behaviour. Garland STMP Press, New York)
An overview of feline social behaviour and communication
The eyes can hold information about the emotional state of the cat, with dilated pupils being commonly associated with fear and narrow pupils being regarded as a sign of contentment. However, it is important to read these signals in association with all the body language that is being displayed since large pupils can also be associated with high arousal unconnected with fear and with poor light levels. Blinking can be used in communication between cats and even from cats to people and it is believed to signal that the cat is seeking reassurance in a tense environment. Staring on the other hand is the sign of a very assertive individual and prolonged eye contact is used to intimidate an opponent, so it is important to avoid such signals when meeting a cat for the first time. The fact that people who like cats are more likely to look at them and try to approach them leads to the paradoxical behaviour of cats in the company of people who dislike them and the tendency for them to head for the one person in the room who finds cats unpleasant to be with. Ear positions can be useful indicators of feline emotion and of the intention to interact but serious confusion can arise if these signals are confused with ear positions in canine communication. Ears that are folded sideways and downwards indicate that the cat is trying to avoid confrontation and is preparing to defend itself from an approaching threat whereas the cat whose ears are flattened against the head with a backwards rotation is getting ready to attack. Ear positions can be altered very quickly and during any encounter it is not unusual to see cats alter their ear position several times as though these small movements are being used to test out the reaction of their opponent.
The role of the tail in feline communication The tail of the cat is often one of its most striking features and its role in the balance and agility of the cat is well recognised. However, the role of the tail in communication is sometimes overlooked and in the past the only comments regarding the tail have related to the belief that the wagging tail of the cat indicates anger and the potential to attack. In fact, the rapid movement of the tail simply indicates that the cat is agitated and is in a state of emotional conflict. Obviously, this may well lead to aggression if the warning goes unheeded but this does not necessarily show that the cat is bad-tempered. In addition to wagging, cats can use their tails to indicate a range of emotions and to assist in their overall communication. During greeting cats will approach with their tail in an upright position and when this tail posture is associated
Figure 4.6 Typical ‘tail up’ greeting which precedes affiliative interaction.
with cats approaching their owners, it appears that the cat is offering a greeting and an invitation to be stroked and played with. In encounters between cats the raised tail signal is usually given before a cat rubs on another cat and this is important as a means of avoiding conflict (Fig. 4.6). Rubbing is a behaviour associated with relative status and if a cat just waded in and rubbed without asking permission he might find himself in trouble, so the raised tail is a friendly gesture used to test out the potential reaction of the other individual and to avoid rejection. Other tail positions have been associated with sexual communication in particular with the signalling of female receptivity and the ‘bottlebrush’ tail is usually associated with fear and defence (Fig. 4.7). Aggressive cats may also use their tail to indicate their intentions, and both the concave and the lowered tail positions are commonly associated with conflict.
35
36
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Figure 4.7 This cat displays a vertically hanging ‘bottlebrush’ tail that indicates fearfulness as it encounters an unfamiliar dog.
37
Chapter 5
Learning theory and behaviour modification
CHAPTER CONTENTS Introduction 37 Classical conditioning 37 Application of conditioned stimuli in the process of behavioural modification 39 Instrumental (Skinnerian, operant, trial and error) conditioning 40 Training classes 41 The need for patience 41 Important points to remember in the application of instrumental learning 41 Behavioural modification techniques 44 Extinction 44 Shaping 45 Systematic desensitisation 45 Counterconditioning 46 Glossary 47
INTRODUCTION Before beginning to tackle the treatment of behavioural problems or starting to offer advice to owners on these subjects, it is necessary to have a basic knowledge of how animals learn since it is this information which will be used in the formation of treatment programmes. Learning theory is a complex subject and further information can be obtained by referring to relevant textbooks (see Further reading). The two methods of learning that are of most importance to veterinary practices involved in behavioural medicine are: ● ●
Classical conditioning Instrumental (operant) conditioning.
CLASSICAL CONDITIONING The best-known example of this form of learning is to be found in the famous experiment involving Pavlov’s dogs when a neutral sound stimulus was paired with the stimulus of food until it elicited the response of salivation in the absence of food. The two main features of classical conditioning as a learning process are that it involves involuntary or reflex responses and it does not rely on the presence of external reward (Fig. 5.1).
Step one: A stimulus known as an unconditioned stimulus (US) in this case food naturally provokes a reflex or unconditioned response (UR) in this case salivation.
Step two: The US is associated with another previously unassociated stimulus (in this case a neutral tone). The previously unassociated stimulus is termed the conditioned stimulus (CS) and this is repeatedly presented to the animal at the same time as the US. Continued
38
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Step three: Eventually the CS alone will evoke the reflex response, which we now term the conditioned response (CR). So, in this example, we reach the situation where the dogs salivate (CR) whenever they hear the neutral tone (CS) regardless of the presence or not of any food.
Classical conditioning UNCONDITIONED STIMULUS (US) e.g. Food
STEP ONE UNCONDITIONED RESPONSE (UR) Salivation CONDITIONED RESPONSE (CR)
STEP TWO CONDITIONED STIMULUS (CS) e.g. Neutral tone
STEP THREE
Figure 5.2 Dogs can learn a conditioned fear of a raised hand after a single incident involving physical punishment. This can continue to affect the animal’s reaction to other forms of hand contact including petting, grooming and play.
Figure 5.1 Classical conditioning.
Everyday examples of classical conditioning include the conditioned fear of a raised hand after an animal has previously been hit (Fig. 5.2) or the sound of a syringe or needle packet being removed before an injection is given. Classically conditioned fears of this kind are highly important in the maintenance of fear and aggression problems. There are numerous ways in which classical conditioning influences the behavioural responses of domestic cats and dogs but one of the most common and easiest to understand is that of house-training young puppies (Fig. 5.3). The key to successful classical conditioning is to ensure that at all times, as far as is possible, the desired conditioned stimuli occur at the same time as the unconditioned stimuli. If this is not the case there is a danger of unintentional conditioning taking place and the unconditioned stimuli becoming associated with extraneous unrelated stimuli. In the case of house-training, examples of unintentional conditioned stimuli include carpets and newspaper. One of the obstacles to successful house-training is the fact that it can be difficult for owners to predict when the unconditioned stimuli are present and therefore it is not easy to ensure that a puppy is outside when they occur. In order to overcome this situation, it is necessary to look for signs that are predictors of a full bladder or full bowel and use these as a guide to timing the coincidence of being outside and needing to eliminate. Predictors of the need to eliminate in a young puppy: ● ● ● ●
Recent meal Recent period of sleep Sniffing around in search of scent marks Period of boisterous play
Step one: An US (in this case the internal sensations that are mediated via the nervous system and which communicate to the brain the need for the animal to either urinate or defecate) naturally provokes a reflex or UR (in this case elimination).
Step two: The US is associated with another previously unassociated stimulus (in this case environmental stimuli associated with being outdoors), again termed the CS. This CS is repeatedly presented to the animal at the same time as the US. In most cases of housetraining a generalised association with outdoors is all that is required, but if owners so wish they can make the CS more specific and train dogs to eliminate in response to more specific stimuli such as a certain substrate or a certain area in the garden. If so desired the CS can be as specific as a verbal command of ‘be quick’ or ‘hurry up.’
Step three: Eventually the CS alone will evoke the reflex response, which is the CR. That is, we reach the situation where the dog will urinate or defecate (CR) whenever it encounters the environmental stimuli associated with being outdoors (CS), regardless of whether the bowel or bladder are completely full.
Learning theory and behaviour modification
Box 5.1 Clicker introduction
House-training UNCONDITIONED STIMULUS (US) e.g. Internal sensations related to full bladder or bowels
●
STEP ONE UNCONDITIONED RESPONSE (UR)
●
Elimination
STEP TWO CONDITIONED STIMULUS (CS) e.g. Stimuli associated with being outdoors
CONDITIONED RESPONSE (CR)
●
STEP THREE ●
Figure 5.3 House-training
In most cases house-training in respect of defecation is achieved more rapidly than training in relation to urination. This is due to the fact that there are fewer incidents of defecation within a 24 hour period and, therefore, there is greater chance that the puppy will be outside on each of these occasions and will rapidly associate the sensation of a full bowel with the presence of external environmental stimuli. The fact that house-training is based on classical conditioning means that there is no need for an external reward but the process can be accelerated by the addition of reward, provided that the timing is accurate. No-one would claim that house-training is easy, but in many cases the process is made unnecessarily more tiresome because owners fail to realize that classical conditioning holds the key to success and that punishment of failure is counterproductive. During the process of house-training there are two important rules to convey to puppy owners: ● ●
The clicker is a reliable and easily reproducible signal that can be used as a consistent signal of reward. The first step is to deliver the sound of the clicker immediately prior to the arrival of a valuable resource, such as a food treat. Within a few repetitions the dog will react to the sound of the clicker with anticipation of the arrival of the reward. After many repetitions the sound of the clicker elicits the same emotional response as the arrival of a food reward and the clicker is now acting as a conditioned reinforcer of that emotional response.
Box 5.2 Using conditioned reinforcers in behavioural modification ●
●
The conditioned reinforcer must only be encountered during the exhibition of an appropriate behavioural response. The conditioned stimulus will need to be periodically associated with the unconditioned stimulus to prevent extinction of the association and loss of the reinforcer status of the conditioned stimulus.
Maximum opportunity to get it right Minimum opportunity to get it wrong
Puppies should never be punished when they make a mistake since they can only do so if the opportunity arises and, if it does, the owner is the one to take the blame.
Application of conditioned stimuli in the process of behavioural modification One of the most frequent applications of classical conditioning in the treatment of behavioural problems is the development of a conditioned stimulus that can then be used in the reinforcement of appropriate behavioural responses; that is, a conditioned reinforcer. There are various examples, including hand signals, whistles and specific praise commands, but one conditioned reinforcer which has attracted a great deal of interest within the dog world is the clicker (Boxes 5.1 and 5.2, Fig. 5.4). Once the clicker has been introduced and has taken on its status as a conditioned reinforcer, it may be used to assist in the instrumental conditioning of certain behaviours, but the initial introduction is done through a process of classical conditioning.
Figure 5.4 Clickers
39
40
BASIC TOOLS IN BEHAVIOURAL MEDICINE
INSTRUMENTAL (SKINNERIAN, OPERANT, TRIAL AND ERROR) CONDITIONING In order for instrumental conditioning to occur there has to be integration of three events; namely a stimulus, a response and a consequence. The nature of the consequence in terms of its effect on the animal will determine the likelihood that the response will occur again if the same stimulus is presented. If the behaviour is more likely to occur in future the consequence is described as a reinforcer; if the behaviour is less likely to be repeated the consequence is described as a punisher. Technically, all consequences of behaviour in instrumental conditioning are forms of reinforcement and to be absolutely accurate it is better to speak about appetitive reinforcement and aversive reinforcement, but the terms reinforcement and punishment are commonly accepted. Unfortunately, however, there is often confusion over the use of these terms and when people start to consider the issues of negative and positive forms of both reinforcement and punishment the situation can become very complicated. In a simplified form, the consequences of a behaviour can be divided into those that increase the probability of a behaviour recurring (the reinforcers) and those that decrease the probability of a behaviour recurring (the punishers). In order to understand the terms ‘positive’ and ‘negative’ in this context it is important to remember that they do not relate to the behavioural outcome under consideration but rather to the manner in which the reinforcer or punisher is delivered.
Definitions Reinforcer: An event which increases the probability of a response. It can be negative or positive. Positive reinforcement: An increase in the frequency of a behaviour when a positive reinforcer (something pleasant) is presented. Negative reinforcement: An increase in the frequency of a behaviour when a negative reinforcer (something unpleasant) is removed (or avoided).
An aversive or unpleasant consequence can therefore be described as a negative reinforcer or a positive punisher, depending on whether it is being presented or withdrawn as a consequence of the behaviour. Likewise, a pleasant or appetitive consequence can be described as a positive reinforcer or a negative punisher, depending on the manner in which the consequence is applied (Fig. 5.5). Some examples that illustrate different situations involving punishment and reinforcement are found in Table 5.1.
Table 5.1
POSITIVE
Situations involving punishment and reinforcement
Canine example
Human example
NEGATIVE Canine example
Human example
Reinforcement
Punishment
Giving food reward when dog sits Giving child a gift for good achievement at school
Smacking a dog for jumping up
Removal of adverse effects of rain by coming inside from the garden Child not having to go to bed at usual time because they are well-behaved
Shouting at a child for misbehaving
Withdrawing attention when a dog misbehaves
Child being denied toy or pocket money as a consequence of bad behaviour
The principles of instrumental conditioning form the basis of animal training and much of behaviour modification, but they are also involved in the unintentional learning of inappropriate responses. We need to remember that dogs are continually learning. Provided a stimulus and a response occur in conjunction with some form of consequence then learning will take place; in this way a lot of so-called problem behaviour is inadvertently learned. For example:
Dogs that bark incessantly when in the car Stimulus: Response: Consequence:
Travelling in the car Barking Car continues on its journey and reaches a pleasurable destination Positive reinforcement of barking
Punisher: An event which decreases the probability of a response. It can be negative or positive.
Dog’s perception:
Positive punishment: A decrease in the frequency of a behaviour when a positive punisher (something unpleasant) is presented.
Dogs that jump up at people when they greet them or are generally over-enthusiastic when visitors call
Negative punishment: A decrease in the frequency of a behaviour when a negative punisher (something pleasant) is removed.
Stimulus: Response: Consequence: Dog’s perception:
Visitors call Jumping up Social interaction, however negative that may appear (e.g., shouting) Positive reinforcement of jumping up
Learning theory and behaviour modification
Figure 5.5 Diagram of the different forms of positive and negative punishment and reward.
Training classes It is generally a good idea to encourage owners to take their dogs to some form of formal training programme, but there are four important messages for the veterinary practice to convey to their clients: 1. Inappropriate training techniques can do immeasurable damage and many behavioural problems are caused or exacerbated by exposure to such techniques. Selection of a training club is a very serious process and owners should take time to visit clubs before they take their puppy along. Training classes which rely on the use of positive punishment techniques and excessive dependence on negative reinforcement should be avoided. Owners need to look for classes where the emphasis is on positive reinforcement and negative punishment techniques. 2. Any situation has potential for learning and the fact that instrumental learning is occurring all the time means that, although training classes are often very useful for organising a routine of training, the learning process is not confined to one particular night of the week in the village hall. 3. The maintenance of behaviour taught in training classes relies on the consistent application of the reinforcement techniques at other times. If alternative behaviours are inadvertently reinforced outside the training class situation they can become established in preference to the behaviours being taught at ‘school’. 4. Behaviours that are taught in the training class location will be specific to that venue unless they are reproduced and reinforced consistently in a number of other situations because dogs are contextual learners. It is therefore vital that owners ‘do their homework’ and apply the same training techniques when the dog is at home and out on walks.
The need for patience A dog will learn more readily if both the required response occurs spontaneously and the required stimulus and con-
sequence can be arranged to occur in conjunction with it than if the response is forced. Obviously this will make training a slow process. The use of clicker training, in which the dog is reinforced for performing a particular behaviour which it has selected itself, and of lure training in which the dog is persuaded into performing a behaviour and is then reinforced for doing so, are both positive forms of training but require a great deal of patience on the part of the owner. The clicker is intended as a training tool and not as a permanent method of reinforcing appropriate behaviour. Transfer from clicker training to alternative long-term methods of reinforcement is known as ‘fading the clicker’. Introduction of an alternative long-term conditioned reinforcer, such as specific verbal praise (‘good dog’), will depend on associating this new consequence with the clicker until the verbal praise alone is acting as the reinforcer of the response.
Important points to remember in application of instrumental learning Correct application of reinforcement (be that appetitive or aversive, negative or positive) is central to the success of instrumental learning. There are a number of important factors to consider including: ● ● ● ●
the nature of the reinforcer or punisher the timing of application of the reinforcement the intensity of reinforcement the schedule of delivery of reinforcement.
Nature of the reinforcer or punisher In order for something to act as a reinforcer or punisher it must be perceived as being appetitive or aversive by the individual animal concerned. When using positive reinforcement techniques it is sensible to use as wide a variety of reinforcers during training as possible since the response is then less likely to become focused onto one particular reward (which may not be available at all times). It also makes sense to use the most effective reward in any given situation and owners need to be reassured that within the context of training their dog there is no such thing as bribery. Whereas in some circumstances praise from the owner is sufficient reward, there are times when a tasty food reward is most definitely the reward of choice. The use of positive punishment is not recommended; in fact it is to be discouraged at all times. One of the obstacles to the effective use of this method of reinforcing responses is that selection of suitable positive punishers is extremely difficult. The aim is to select something that is mildly aversive to the animal and not one that causes fear. This selection will depend on the species, breed and individual characteristics of the animal and there is huge potential for error.
41
42
BASIC TOOLS IN BEHAVIOURAL MEDICINE
EXAMPLE: TEACHING A DOG TO SIT Response required: Dog sits Stimulus required: Verbal command from owner Ultimate consequence: Praise from owner Dog’s perception:
Training methods Lure training
Final stage: Stimulus:
Stage one Lure into sitting using food treat placed just above nose and gently moved upwards and backwards, resulting in dog entering into sit position. As the dog sits, and not before: Stimulus: Give ‘Sit’ command Response: Dog already in sit position Consequence: Give food treat and verbal praise while dog is in sit position Dog’s perception: Positive reinforcement of being in sit position
Response: Consequence:
Stage two
Dog’s perception:
Second stimulus:
Response: Consequence:
Repeat stage one several times.
Stage three Once dog sits as it sees the hand raise it is time to use the stimulus (voice command or hand signal) as a predictor of the behaviour. Now the command should be given while the dog is still standing: Stimulus: Give sit command or raise hand (as if with treat inside) Response: Dog enters sit position Consequence: Give food treat and verbal praise as sit position is achieved Dog’s perception: Positive reinforcement of entering sit position
Stage four Once the dog will reliably enter the sit position on hearing the verbal command or on seeing the visual hand signal, it is important to teach the dog that it is required to stay in the position until instructed to do something else. In order to achieve this the time delay between entering the sit position and receiving the reinforcement needs to be gradually extended. Failure to do this will result in a dog that bobs in and out of the sit position believing that it is the act of entering the position that yields reward rather than remaining in the position. Stimulus: Give sit command or raise hand (as if with treat inside) Response: Dog enters sit position Consequence: Wait for a very short time before giving food treat and give verbal praise while dog is still in sit position. (The time
between entering the sit and receiving the reinforcement should be very gradually extended.) Positive reinforcement of remaining in sit position Give sit command or raise hand (as if with treat inside) Dog enters sit position Wait for a very short time before giving food treat and verbal praise, while dog is still in sit position Give release command (gesture to dog to come toward owner and as it leaves the sit position give release command e.g., ‘enough’) Dog leaves sit position Give food treat and verbal praise as dog leaves sit position Positive reinforcement of entering sit position on command, remaining in sit position and leaving position on command
Clicker training Remember that the clicker must be introduced and established as a conditioned reinforcer before it can be used. The clicker can be incorporated into the lure training method as the conditioned reinforcer, which is used as the positive consequence of the required response, or it can be used alone without the incorporation of a lure. The main difference between clicker training (without a lure) and lure training lies in stages one and three of the process. In clicker training there is no stimulus involved in stage one since this method starts by reinforcing the dog’s own spontaneous behaviour and there is no need for stage three since the clicker can be used to reward the act of sitting in stage one.
Stage one Response: Consequence: Dog’s perception:
Dog spontaneously enters sit position Clicker is heard as dog enters sit position and food reward follows Positive reinforcement of entering sit position
Stage two Repeat stage one several times. Stages four and five are the same as for lure training, except for the use of the clicker as the reinforcer for the appropriate behaviour.
Learning theory and behaviour modification
Reinforcers and punishers can be primary or secondary in nature. ‘Primary’ refers to the fact that they are inherently appetitive or aversive while ‘secondary’ refers to those consequences of behaviour which are inherently neutral but have acquired reinforcing properties by contiguous association with a primary reinforcer or punisher (Table 5.2).
Table 5.2
Appetitive versus aversive reinforcers for dogs Appetitive reinforcers
Aversive reinforcers
PRIMARY
Food Play Canine or human social interaction (assuming successfully socialised)
Pain Surprise or shock Social isolation Fear
SECONDARY
Specific verbal praise, e.g., ‘Good dog’ Clicker
Verbal reprimands, e.g., ‘No’ Training aids which induce pain or fear, e.g., shock collar or freedom fence
In order for secondary reinforcers or punishers to be effective they have to be highly-predictive of an appetitive or aversive outcome and this predictive value is referred to as contingency. For example:
High level of contingency: The sound of a clicker used as a reinforcer when it is always followed by the arrival of a treat and is never encountered in any other situation.
Low level of contingency: The sound of a rattling bunch of keys used as a punisher when the dog hears the keys being picked up and rattled at a variety of times with inconsistent results.
Timing of application of the reinforcement Successful timing is crucial to the instrumental learning process. Reinforcers or punishers must be delivered at the same time as the response, or immediately afterward, if they are to be effective. A delay of even 1 second can weaken the effect or even result in inadvertent reinforcement of a response other than the one which was intended. The relationship in time between the reinforcer and the behaviour is referred to as contiguity. Events that are contiguous occur at the same time. Poor timing of application of appetitive or aversive reinforcers is at the heart of many a behavioural problem. It is worth reminding owners that interaction with their dog influences whatever the dog is doing at that time and so they need to pause and ask themselves, ‘Is what my dog is doing at this precise moment something which I wish him to continue doing?’. If the answer is ‘yes’ then go ahead and interact with him with some form of appetitive reinforcement, but if the answer is ‘no’: STOP!
Intensity of reinforcement When using positive reinforcement methods, it does not always follow that the more intense a reward the more effective it is. In some circumstances it is necessary to use a very intense reward in order to increase the level of motivation to perform the behaviour or to compete with other
EXAMPLE: HOUSE-TRAINING A DOG Example 1 (✕) Desired response: Actual behaviour: Consequence: Timing: Dog’s perception: Effect:
Dog’s perception: Toileting in garden Toileting in house Food treat and verbal praise Delivery of reward as dog comes back into house from garden Positive reinforcement of entering home No effect on location of toileting; increased anticipation of reward when entering house from garden
Example 2 (✕) Desired response: Actual behaviour: Consequence: Timing:
Toileting in garden Toileting in house Use of verbal or physical reprimand Delivery of punishment when dog caught toileting in house
Effect:
Positive punishment of toileting in front of owner No effect on location of toileting; increased anticipation of toileting in front of owner, resulting in dog not toileting if owner is present, even when in garden!
Example 3 (✔) Desired response: Actual behaviour: Consequence: Timing: Dog’s perception: Effect:
Toileting in garden Toileting in house Verbal praise Delivery of reward as dog is in the act of toileting in garden Positive reinforcement of toileting in garden Enhancement of classical conditioning of being outside and toileting
43
44
BASIC TOOLS IN BEHAVIOURAL MEDICINE
potential reinforcers within the environment; for example, training a dog to respond to commands in the presence of distracting stimuli (teaching a recall in the park when there are discarded chip papers under the bushes). However, when circumstances call for the dog to respond calmly then a reward that is highly intense can have the opposite effect by inducing too high a level of excitement and preventing the dog from performing the desired behaviour. In these situations it is important to use a low level of reward intensity. An example is teaching a dog to greet visitors at the door calmly. Use of a highly rewarding food treat in the hand of the visitor may encourage the dog to be excitable and to jump up. Calm verbal or tactile interaction may be more beneficial. When considering the use of positive punishment methods the punisher must be applied at the first presentation and at a sufficient strength to stop the behaviour. This fact makes the application of positive punishment very difficult to achieve and is one of the many reasons why it is an unsuitable method of training in the hands of inexperienced trainers and owners. The intensity of the punisher needs to be exactly correct in order to avoid the situation where the punishment is too weak to have any effect or so strong that it induces fear or even aggression. The optimum level is the minimum required to be effective in suppressing the response. This optimum punishment level will depend on the individual animal, the reaction varying with its species, breed, temperament and previous experience. What has no effect on one dog may severely frighten another. Gradual increases in intensity from an initial low level may be ineffective because the dog will adapt to these increases and eventually need an even greater intensity of punishment to suppress the behaviour. The intensity of punishment will also be related to the type of behaviour which is involved since the more motivated an animal is to perform a behaviour the more intense the punishment will have to be in order to stop it. It is also worth bearing in mind that, where punishment is repeated, the dog is likely to become habituated to it. Thus a punishment that was effective in stopping the behaviour the first few times may become gradually less and less effective, resulting in a situation where the owner finds themselves using steadily more severe forms of punishment to achieve the same result.
Schedule of reinforcement Reinforcement can be delivered on a continuous or partial schedule. While an animal is learning to behave in a new way, it will learn most quickly if its responses are reinforced on each and every occasion; this is described as a continuous schedule of reinforcement. When applying positive reinforcement in order to increase the occurrence of a new behaviour, it is important to tailor the schedule of delivery to the stage of learning. In
other words, behaviour that is continuously reinforced will be quickly incorporated into the behavioural repertoire but it is also highly susceptible to extinction (the removal of a behaviour from a behavioural repertoire) since the failure to deliver the reinforcer will be readily noticed. Therefore, once the behaviour is established it is important to vary the schedule of reward and employ partial reinforcement schedules which improve the maintenance of the response and result in higher rates of response and greater resistance to extinction. Intermittent and irregular reward is the most effective way of making any behaviour resistant to extinction and this is the basis of the gambling habit in humans. Whilst this is very useful in the maintenance of wanted behaviour, it can also lead to problems in the treatment of behavioural problems since an unwanted behaviour that has been intermittently rewarded, often unintentionally, can take some considerable time to extinguish. When applying positive punishment techniques in order to decrease the occurrence of an unwanted behaviour, the process is most effective when the punisher is administered on a continuous schedule and every occurrence of the unwanted behaviour is punished. Partial reinforcement schedules can be either fixed or variable and can be determined by time intervals or by ratios of responses. When using partial schedules, it is important to ensure that there are sufficient occurrences of the reinforcement for learning to occur. If the intervals are too long or the ratios too high then the behaviour will be prone to extinction. Animals tend to work harder to perform the desired behaviour when reinforcements are: ● ●
relatively few and far between relatively irregular and unpredictable.
BEHAVIOURAL MODIFICATION TECHNIQUES
Extinction The removal of a behaviour from a behavioural repertoire is termed ‘extinction’ and it is an extreme form of negative punishment. Every time a behaviour is performed reward is taken away or withheld. Extinction needs to be applied on a continuous schedule and ensuring that a behaviour is never rewarded is the safest and most reliable method of removing that behaviour from the animal’s repertoire. It is important to remember that behaviours can be rewarded internally as well as externally and therefore application of extinction as a means of modifying a behaviour can have limitations. Behaviours which are inherently rewarding to the animal will continue even if the external rewards, that is those rewards which are under the influence of the owner, are removed. In addition, the removal of external reward must be complete for the process of extinction to be effective and in households with more than one family member there
Learning theory and behaviour modification
is a risk that reward may still be available from one source and so lead to failure of the extinction process. One of the main difficulties that owners experience when attempting to implement an extinction programme is related to the ‘frustration effect’. When a behaviour has been previously reinforced and that reinforcement is abruptly removed, the animal will respond to the resulting frustration by performing the behaviour more frequently and more intensely in an attempt to gain access to the reward. Persistent withdrawal of reinforcement is therefore essential since transfer onto an intermittent schedule of reinforcement will prolong the process of extinction.
Shaping In some situations the required response in training or in behaviour modification is so far removed from the animal’s present behaviour that it is impossible to make the change in one step. When this is the case, it is possible to use a learning process whereby the animal is positively reinforced for performing successive and increasingly accurate approximations of the target behaviour. This process is called shaping. The command or cue for the target behaviour is not introduced until the animal has succeeded in performing that response in its entirety. The process begins by reinforcing whatever aspect of the animal’s behaviour is closest to the desired response. Once
this behaviour occurs more often, the trainer withholds reinforcement until some closer approximation to the desired response occurs and this series of steps continues until the desired response is achieved. The most notable use of this technique is in the training of performance animals; for example, in television adverts or films. However, shaping can also be useful in modifying an animal’s response.
Systematic desensitisation Systematic desensitisation is a method used to gradually reduce an animal’s response to a stimulus until the animal remains in a neutral emotional state when the stimulus is presented. It is achieved by gradually exposing the animal to increasingly intense forms of the stimulus while the animal is relaxed. Systematic desensitisation is commonly used in the treatment of fears and phobias and it is important to identify the separate elements of a fear-inducing situation and present these components to the animal separately so that it can learn to relax in their presence. It is also important to present the fear-inducing stimuli in a diluted form in the early stages of treatment in order to avoid the induction of a fear response. This is easy to achieve with sound stimuli since CDs and cassette tapes enable the owner to effectively dilute the stimulus and gradually increase the volume. Visual stimuli on the other hand can
EXAMPLE: A DOG THAT BEGS AT THE TABLE Stage one Stimulus: Response: Consequence: Dog’s perception:
Family eating food at table Dog begging and salivating at table Food given to dog by various family members Positive reinforcement of begging behaviour
Stage two (Decision made to try to change dog’s behaviour) Stimulus: Family eating food at table Response: Dog begging and salivating at table Aim: Stop dog begging at table Consequence: No food given to dog at table Dog’s perception: Need to work harder for previously continuously delivered reinforcement Result: Dog makes more deliberate begging action and starts to bark at people for food while they are at table. One family member gives in and feeds dog Dog’s perception: Positive reinforcement of begging behaviour In order to improve the success of extinction as a behavioural modification technique it is useful to teach an alternative and
incompatible behaviour in the same context as the behaviour being extinguished.
Stage one Stimulus: Response: Consequence: Dog’s perception:
Family eating food at table Dog begging and salivating at table Food given to dog by various family members Positive reinforcement of begging behaviour
Stage two (Decision made to try to change dog’s behaviour) Stimulus: Family eating food at table Response: Dog begging and salivating at table Aim: Stop dog begging at table Consequence: No food given to dog at table but reward given if dog sits in bed while family eating at table Dog’s perception: Positive reinforcement of ‘being in bed’ behaviour Result: Dog elects to sit on bed while family eat, in anticipation of reward
45
46
BASIC TOOLS IN BEHAVIOURAL MEDICINE
be harder to dilute, but introducing items in miniature toy form or from a distance are both possible approaches to this problem. One of the limitations of desensitisation is that its best result is an animal that has no emotional reaction to the stimulus and this leaves the possibility that the problem behaviour can re-emerge or generalise. If a desensitised animal is exposed to the full-blown form of the stimulus unexpectedly, it can easily be sensitised again because desensitisation is a reversible process. In order to avoid such problems in behavioural practice, the process of systematic desensitisation is usually combined with counterconditioning in any treatment protocol.
Counterconditioning This is the process by which an animal’s emotional or behavioural response to a stimulus is altered by conditioning a response which is incompatible with the unacceptable behaviour or emotion that currently exists. It is possible for counterconditioning to be carried out in either a classical or an operant manner. Operant counterconditioning is also referred to as ‘response substitution’.
Classical counterconditioning This is used in the treatment of fears and phobias and involves association of the fear-inducing stimulus with a stimulus that evokes a positive emotional state. The aim is to repeatedly present the stimulus in association with something that the dog is known to enjoy, such as food or play. In order for this technique to be effective, it is essential
that the association between the pleasant stimulus and a positive rewarding emotional state is stronger than the association between the fear-inducing stimulus and the unpleasant emotional reaction. (The strength of the association is depicted in Fig. 5.6 by the size of the arrows.) If this is not the case, there is a risk that the previously pleasure-inducing stimulus will become associated with an emotional state of fear. It is therefore beneficial to begin with a programme of systematic desensitisation to reduce the intensity of the fear reaction before commencing the counterconditioning. A common example of this is seen when people offer food treats to fearful dogs in an attempt to decrease their fear of strangers. If the fear of strangers is stronger than the positive reaction to the food treat, the dog may become frightened of the act of being offered food treats. It is therefore beneficial to reduce the intensity of the fear reaction by diluting the perceived threat from the person and this can be achieved by asking the stranger to drop food treats onto the floor, but not speak to or look at the dog while this is done. This is sometimes referred to as a ‘no strings’ approach as the pleasant experience in the presence of the stranger does not rely on any behavioural response from the dog and there is no pressure for the dog to approach the person directly or cope with an approach from them. When it is carried out successfully, classical counterconditioning has a blocking effect that reduces the chance of resensitisation and generalisation occurring when the animal encounters the fear-inducing stimulus in the future. Systematic desensitisation and counterconditioning therefore complement one another and work to reduce and replace the conditioned emotional response of fear.
Figure 5.6 Classical counterconditioning.
Classical counterconditioning UNCONDITIONED STIMULUS (US) e.g. Food, play or social interaction STAGE 1 UNCONDITIONED RESPONSE (UR) Emotional state of pleasure CONDITIONED RESPONSE (CR) STAGE 2 STAGE 3
CONDITIONED UNPLEASANT RESPONSE (CR) Emotional state of fear
STAGE 1 CONDITIONED STIMULUS (CS) e.g. Veterinary practice, fireworks, thunder, situation
Learning theory and behaviour modification
Response substitution When counterconditioning involves replacing an unwanted behaviour with an acceptable conditioned response, it is referred to as response substitution. The new response must be incompatible with the old one and, in order for this technique to be effective, it is essential that the motivation to perform this new incompatible behaviour is greater than that for the unwanted behaviour. The first step in response substitution is to condition the ‘new’ behaviour and this should be done in a context that is unrelated to the problem behaviour and in which there are few distractions. It is
important to develop a strong association between the conditioned stimulus, or ‘cue’, and the conditioned response. A high level of contingency will assist in increasing the motivation to perform this new behaviour when the process of response substitution is carried out within the problem context. Once the new behaviour has been conditioned, it can be introduced to the dog in the presence of the stimulus which triggers the undesirable response. It is helpful to present the stimulus in a diluted form to begin with and then gradually work up to the situation where the full-blown stimulus is presented.
EXAMPLE: DOG REACTS TO CERTAIN THEME MUSIC ON TELEVISION BY JUMPING ONTO FURNITURE Stage one
Stage four
Teach dog to sit on a designated ‘bed‘ area by using clicker training at times when the television is switched off.
When the dog has successfully completed stage three, the television should be switched on at the correct time for the theme music but with the volume control set very low. While the music is playing the dog should be commanded to go ‘on your bed.’ Gradually, over a period of a few days the volume should be increased.
Stage two When the dog sits on the bed reliably introduce a cue command such as ‘on your bed’ and reinforce the response by using positive reinforcement techniques as described earlier.
Stage three
Stage five
When the dog will sit on the bed readily in response to the command make a tape recording of the theme music and, in the presence of ever-increasing volumes of the theme music from the tape recorder, give the dog the command ‘on your bed’ and reward it for responding. Remember to ensure that the dog is rewarded while it is in the bed location.
In this stage the ‘on your bed’ should be faded out. While the theme music is playing the command ‘on your bed’ should be given in a steadily decreasing volume until there is no command at all and the dog is responding to the onset of the theme music (the conditioned stimulus) by going to its bed (counterconditioned response).
A GLOSSARY OF TERMS USED IN ASSOCIATION WITH LEARNING THEORY Blocking: where the learning of a conditioned stimulus as a predictor is blocked by the pre-existence of a conditioned stimulus that is a better predictor. Classical conditioning: when a neutral stimulus precedes and becomes a predictor of the unconditioned stimulus, eliciting a response even in the absence of the unconditioned stimulus. Conditioned response: the response to a conditioned stimulus. Conditioned stimulus: a neutral stimulus which, through pairing, becomes the predictor of the unconditioned stimulus. Contingency: the predictive value of a reinforcer. Contiguity: the relationship in time between a reinforcer and a behaviour.
Counterconditioning: where the response to a conditioned stimulus is altered by associating it with a new unconditioned stimulus to condition a new response incompatible with the first. Discriminative stimulus: a signal with a high level of contingency. Extinction: removal of a behaviour from the behavioural repertoire of an individual. Flooding: exposure to a noxious stimulus without the opportunity to escape. Frustration effect: An increase in vigour of a behavioural response immediately following the non-reinforcement of a previously reinforced response. Generalisation: the triggering of a behavioural response by stimuli that are decreasingly similar to the original trigger.
47
48
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Habituation: the process whereby an animal becomes accustomed to non-threatening environmental stimuli and learns to ignore them. Instrumental conditioning: a type of associative learning in which an important event follows a response, resulting in a change in the probability of the response. Latent inhibition: exposure to a stimulus without significant aversive consequences such that subsequent aversive effects of exposure to that stimulus have minimal effect on the animal’s behaviour. Learned helplessness: a failure to learn an avoidance or escape response to an aversive stimulus due to previous experience where the subject could not escape from the noxious experience.
Reinforcement: a consequence which increases the probability of a response. Secondary conditioning (Second order conditioning): pairing a stimulus with a previously conditioned stimulus. Sensitisation: where the arousal caused by one stimulus causes greater reactivity to presentations of another. Systematic desensitisation: reduction of the response to a noxious stimulus by relaxation rather than the introduction of a second unconditioned stimulus. Shaping: a form of training where approximations to the desired behaviour, becoming increasingly specific over time, are reinforced. Stimulus: that which an organism senses.
Operant conditioning: another term for instrumental learning.
Trial-and-error learning: another term for instrumental learning.
Pavlovian conditioning: another term for classical conditioning.
Unconditioned stimulus: a stimulus that elicits a response without any training.
Punishment: a consequence which decreases the probability of a response.
Unconditioned response: the response elicited by an unconditioned stimulus.
49
Chapter 6
The role of pharmacology in behavioural medicine
CHAPTER CONTENTS Introduction 49 Psychopharmacology – special considerations 49 Drugs are not a substitute for behavioural workup 50 Neurotransmission 50 Managing psychoactive drug therapy 50 Case selection 50 Monitoring 51 Termination of treatment 51 Classes of psychoactive drug 51 Neuroleptics 51 Azapirones 51 Benzodiazepines 52 Tricyclic antidepressants (TCAs) 53 Selective serotonin re-uptake inhibitors (SSRIs) 54 Monoamine oxidase inhibitors (MAOIs) 54 Beta-blockers 55 Antiepileptics 55 Central nervous system (CNS) stimulants 56 Hormonal preparations 56 Antihistamines 57 Alpha-adrenoreceptor stimulants 57 Alpha-adrenoreceptor antagonists 57 Xanthine derivatives 57 Pheromonatherapy (as an adjunct to behavioural therapy) 58
INTRODUCTION The drugs that are relevant to specific behavioural conditions are discussed in the relevant chapter in this book; this chapter is designed to give an overview of the classes of medication that can be used in behavioural medicine. The drugs covered in this book are those that are most likely to be used by a general practitioner treating behavioural cases; information about other medications that may have a place in specialised behavioural medicine practice can be found in other texts (see Further reading). Full monographs for each of the medications described here are available in veterinary formulary publications (see Further reading).
PSYCHOPHARMACOLOGY - SPECIAL CONSIDERATIONS The majority of the drugs used in the field of behavioural medicine are unlicensed for veterinary use and will be used in an extra-label fashion. Clients must be made aware of this fact and informed consent forms should be used. The use of human medical preparations also raises the issue of potential client abuse and this should not be overlooked. Requests for frequent repeat prescriptions should be viewed with suspicion and it is advisable to limit dispensing to 1 month’s supply at a time, with a revisit and re-examination being necessary before repeat prescriptions can be given. One very important consideration when contemplating the use of psychoactive medication is the need for client cooperation over administration. Many of the drugs take a considerable time to take effect and owners need to understand the need for relatively long-term administration (months rather than weeks). More than one dose is listed for some drugs in view of the fact that there are multiple doses cited in the literature and, since research into the use of psychoactive medication in animals is ongoing and dosages are prone to alteration, it is highly recommended that veterinary surgeons consult the most recent publications in the field for the current dosage regimes. Where possible, the lowest effective dose
50
BASIC TOOLS IN BEHAVIOURAL MEDICINE
should be used and in most cases gradual withdrawal of medication is recommended.
Drugs are not a substitute for behavioural workup The use of pharmacological intervention without an adequate behavioural workup is bad practice and medication should be used as a combination therapy alongside behavioural modification techniques. Concomitant behavioural therapy is needed in order to deal with the learned component of the behavioural problem and also to address the cause of the condition as well as the symptoms. Where the veterinary surgeon concerned is not able to offer appropriate behavioural therapy advice, the case should be referred for this aspect of treatment. Where possible, referral of cases involving the use of psychoactive medication should be made to a veterinary behaviourist but where this is not possible, referral to a non-veterinarian for provision of behavioural therapy is encouraged. However, the medical care of the patient remains the responsibility of the referring veterinary surgeon and queries regarding the use of psychoactive medication should be directed to a veterinary behaviourist. Prescription of medication for behavioural cases should follow the same principles as prescription in any other field of veterinary medicine and should be based on a sound diagnosis of the cause of the symptoms seen (Box 6.1).
NEUROTRANSMISSION Before using psychoactive drugs it is necessary to understand the principles of neurotransmission. This holds the key to understanding the action of drugs on the brain, the effects of disease on the central nervous system (CNS) and the behavioural consequences of psychoactive drug treatment for animals. There are a number of agents that act as neurotransmitters within the body and new ones are being discovered on an almost daily basis. This is a very dynamic science and an area of active research. The most important neurotransmitters in behavioural medicine are: ● ● ● ●
Serotonin (5HT) Dopamine γ-aminobutyric acid (GABA) Norepinephrine (noradrenaline)
When considering the use of psychoactive medication, it is important to understand the manner in which neurotransmitter action is terminated. The most common methods are: ● ●
The commonly used psychoactive drugs act on these two systems and thereby modify the availability of neurotransmitters within the CNS. Detailed information regarding mode of action is outside the remit of this book and veterinary surgeons are advised to consult a comprehensive text on psychopharmacology in order to increase their knowledge in this area (see Further reading).
MANAGING PSYCHOACTIVE DRUG THERAPY
Case selection When considering drug usage in behavioural medicine cases, there are some important steps that need to be taken. A complete medical and behavioural history is required in all cases and all patients must undergo a full medical and behavioural examination. Prior to commencing drug treatment, it is advisable for all patients to undergo a basic haematology and biochemistry screen. Tests for hepatic and renal function are advisable, as is monitoring of cardiac function (Box 6.2). There are three main reasons for good medical pretreatment workup: ●
●
●
●
● ● ● ● ●
Pharmacological intervention
Relies on sound diagnosis Relies on client cooperation over administration Is open to client abuse Is very rarely sufficient alone Needs concomitant behavioural therapy
Detection and/or exclusion of potential medical conditions that could responsible for the behavioural symptoms Detection and/or exclusion of potential medical conditions that could affect the use of psychoactive medication (e.g., medical contraindications for particular drug classes) The setting of a baseline normal of biochemical and haematological parameters for the particular individual to facilitate patient monitoring during long-term drug administration.
Caution is always needed when considering drug therapy in cases where the animal: ●
Box 6.1
Re-uptake Enzymatic destruction
●
is old has metabolic or cardiac abnormalities is or has been receiving other medication.
Although there are very few drugs that are specifically licensed for behavioural indications in veterinary medicine, there is an extensive range of medications that are potentially useful in behavioural cases. When considering drug therapy, the main considerations are the ability to reach an accurate diagnosis and the selection of a drug that is appropriate.
The role of pharmacology in behavioural medicine
Box 6.2 criteria ● ● ● ●
Selecting cases for drug therapy – some
The behavioural diagnosis The duration of the problem The severity of the symptoms The risk of euthanasia/rehoming and resulting need for quick results
Monitoring In view of the fact that medication in behavioural cases is likely to be given for periods of months rather than weeks, it is important to consider the issue of patient monitoring. A complete medical examination and blood workup should be carried out every 6 months if patients are staying on drugs long term and owners must be informed of any known potential side-effects. Dosages should be adjusted according to development of the case and terminated when satisfactory results have been achieved (Box 6.3).
Box 6.3 Potential risks involved with drug therapy in behaviour cases ● ● ● ● ● ●
Medical side-effects Behavioural side-effects Sedation interfering with learning ability Owner reliance on medication Lowered compliance with behavioural modification Masking behavioural symptoms without dealing with the underlying cause
Termination of treatment When the time comes to remove medication in behavioural cases, the withdrawal should be made gradually. If another class of psychoactive medication is thought necessary there should be a 2-week washout period during which no medication is given. Accurate diagnosis is central to the appropriate use of veterinary psychopharmacology in behaviour modification.
CLASSES OF PSYCHOACTIVE DRUG
Neuroleptics This group of drugs is also referred to as antipsychotic agents in human psychiatry and the most commonly used class of drugs within this group is the phenothiazines. The value of neuroleptics within veterinary behavioural medicine is rather limited and although high potency neuroleptics, such as haloperidol and perphenazine are
discussed in the behavioural literature, their use is largely restricted to specialised behavioural practice. Phenothiazines are routinely used in general practice for the purposes of sedation and restraint and the most commonly used member of this class, acepromazine, has a specific application in premedication. Traditionally, this drug has been used in the treatment of behavioural problems associated with car travel and in the management of fears and phobias, particularly related to fireworks and thunderstorms, but its use in these conditions is now considered to be outdated and inappropriate. Acepromazine exerts its therapeutic actions by blocking dopaminergic receptors in the brain. Its action is not selective and therapeutic effects cannot be achieved in isolation from CNS depression. While sedation may be desirable in short-term management of fear-related problems, acepromazine has been associated with increased sensitization to noise which makes it a poor choice in the treatment of sound phobia. A major disadvantage of acepromazine is the blocking of motor responses while leaving sensory perception unaffected. The animal is therefore aware of the fear-inducing stimulus but limited in its ability to react. This can result in worsening of the phobia over time and treatment with acepromazine for firework phobias can be associated with increasing severity of the phobic reaction from year to year. The major behavioural contraindication for phenothiazine use is aggressive behaviour, since acepromazine can lead to behavioural disinhibition. In addition, there are medical contraindications including epilepsy, brachycephalic breeds, history of respiratory depression, hepatic dysfunction, renal compromise and hypotension. Use of acepromazine in geriatrics (over 8 years of age) carries particular medical concerns in terms of hypotensive effects. If acepromazine is to be used, it is advisable to carry out a pre-treatment biochemistry screen to assess renal and hepatic function. The use of acepromazine as a treatment in behavioural cases has decreased significantly in recent years and its relevance to behavioural medicine is severely limited. In most cases, other drugs should be considered in preference.
Azapirones The only member of this class that is used to any extent in veterinary behavioural medicine is buspirone. It has been advocated for the treatment of mild anxiety-related problems and, within the primary literature, most references to its application in a veterinary context relate to the treatment of urine spraying in cats. It is reportedly ineffective when the animal is exposed to intense fear-inducing stimuli and is therefore not advised in cases such as sound phobia or separation anxiety in dogs. The exact mode of action of azapirones is not known but their primary action appears to be as serotonin agonists,
51
52
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Table 6.1
Azapirones
Indications:
Dose:
Contraindications and special notes
Treatment of mild to moderate anxietyrelated behaviour problems in dogs and cats. Treatment of urine spraying in cats when associated with mild anxiety.
BUSPIRONE Dog: 1 mg/kg 2 to 3 times daily Cat: 0.5–1.0 mg/kg 2 to 3 times daily For urine spraying – 5 mg/cat 2× daily for 1 week; if patient responds continue treatment for 8 weeks and then gradually withdraw. If no response, cease treatment.
Contraindicated in states of renal or hepatic impairment and in epileptics. May take 2 weeks to take effect. May cause behavioural disinhibition and increased friendliness (in cats). Contraindicated in multi-cat households due to potential paradoxical increase in intraspecific aggression.
although they are also reported to have noradrenergic and dopaminergic effects and may also suppress cholinergic pathways. Specific advantages to buspirone use are that it does not interfere with learning and it causes minimal problems on withdrawal. However, onset of action can be between 1 and 3 weeks and administration two to three times a day can be limiting in terms of its practical application in behaviour cases. Physical side-effects of busprione are minimal and reports have mainly related to mild gastrointestinal disturbance in the early days of administration. The main behavioural consideration when using buspirone is that it may cause a paradoxical increase in aggression in some cats and therefore its use in multi-cat households is not recommended (Table 6.1).
Benzodiazepines The two most commonly used drugs in this class are diazepam and alprazolam. Other benzodiazepines mentioned in behavioural medicine literature include clo-
Table 6.2
razepate, lorazepam, oxazepam and temazepam. The main indication of this drug class is for the treatment of anxietyrelated behaviour problems in dogs and cats, and their indications in the literature have been far ranging. In cats, the most common indication has been for the treatment of urine spraying, but in recent years their use has been superseded by the use of antidepressants such as clomipramine. In dogs, the primary indication is as a short-term therapy for phobias, including sound phobia such as fireworks, and in these cases the side-effect of interference with short-term memory is beneficial. However, in other behavioural cases memory-blocking activity can be limiting and the use of benzodiazepines on a long-term basis is not advisable in situations where concurrent behavioural modification is required. In cats, one of the main concerns relating to the use of benzodiazepines is the risk of idiopathic hepatic necrosis, which has been reported in clinically normal cats within 7 days of oral administration of diazepam. This reaction is rare but can be irreversible and fatal and should therefore be taken into consideration in any case where diazepam administration is being considered. Monitoring of hepatic
Benzodiazepines
Indications:
Dose:
Contraindications and special notes
Treatment of anxiety-related behaviour problems in dogs and cats. Short-term treatment for phobias including sound phobias, e.g., of fireworks.
DIAZEPAM Dog: 0.55–2.2 mg/kg po q 6–24 hours Cat: 0.22–0.4 mg/kg po q 12–24 hours ALPRAZOLAM Dog: 0.01–0.1 mg/kg po q 8–12 hours Cat: 0.12–0.25 mg/kg po q 12 hours CLORAZEPATE Dog: 0.01–0.1 mg/kg po q 8–12 hours Cat: 0.125–0.25 mg/kg po q 12 hours
Contraindicated in states of hepatic impairment. May cause paradoxical excitation or anxiety – should be tested in presence of owner on first administration. Caution in cats, especially if longer term use being considered. Do not allow cats treated with benzodiazepines access to outdoors due to limitation of depth perception. Interferes with short-term memory, therefore long-term use limited. Alprazolam: more rapid onset of action and considered preferable for feline cases. May cause disinhibition of aggressive behaviour.
The role of pharmacology in behavioural medicine
function in cats prior to the use of diazepam and within 1 week of the commencement of therapy is strongly recommended. In dogs, the benzodiazepines are generally well-tolerated but reports of sedation, ataxia and muscle relaxation soon after oral administration are common. Reduction in these side-effects is usually seen within a few days but the onset of paradoxical excitation or anxiety should result in withdrawal of the medication, and it is recommended that the first dose of a benzodiazepine is always administered when the animal can be carefully observed and monitored for such a reaction. The risk of behavioural inhibition prohibits the use of benzodiazepines in cases of canine aggression. The current thinking is that benzodiazepines are best suited to short-term use in the management of acute anxiety episodes but in cases where they have been used on a long-term basis, care should be taken over their withdrawal. So-called ‘discontinuation syndrome’, which is characterised by resurgence of the initial behavioural symptoms and an onset of nervous behaviour, and even seizures, has been reported in the literature following sudden withdrawal of benzodiazepine therapy. In order to avoid this, it is recommended that the dose is gradually tapered and that abrupt termination of therapy is avoided. The potential for human abuse of these drugs should not be underestimated. Strict control of drug dispensing is needed and it is recommended that prescriptions are limited to 1-month’s supply of medication at a time in order to facilitate effective monitoring of drug usage (Table 6.2).
Tricyclic antidepressants (TCAs) This drug class is one of the most widely used within behavioural medicine and the variety of indications reflects the subtle differences in the mode of action of the various drugs within it. The TCAs effect their antidepressant action
Table 6.3
by blocking the re-uptake of serotonin and norepinephrine, but the proportional effects on these two neurochemicals varies considerably between the individual drugs within the group. In addition, TCAs commonly produce effects related to their activity at other receptors such as muscarinic and antihistaminic sites and these may be manifested as unwanted side-effects or potentially useful therapeutic effects, depending on the drug in question. Sedation is a common side-effect of medication with the TCAs and appears to be most pronounced in the early stages of treatment. The level of sedation is usually dosedependent and reports in cats are often linked to unintentional overdose in that species. Dry mouth, urinary retention and constipation are commonly reported but are usually transient and not severe. Antihistaminic sideeffects may be considered beneficial in conditions which include some pruritic effect and doxepin has been specifically indicated for the treatment of canine acral lick dermatitis for that reason. Concerns have been raised over the potential for cardiac side-effects when using TCAs but the literature suggests that such effects are benign when the drugs are administered to healthy individuals and within the recommended therapeutic range. However, cardiac assessment is recommended prior to instituting treatment with TCAs since conduction disturbances may occur in predisposed animals and the use of these drugs is therefore contraindicated in any individual exhibiting a cardiac arrhythmia. Probably the most well-known TCA in veterinary use is clomipramine, not least because it is one of the rare drugs which carries a veterinary licence for a behavioural indication. Marketed by Novartis Animal Health, Clomicalm ® is licensed for the treatment of separation anxiety in dogs but, at a practical level, the product is used for a far wider range of indications, including canine compulsive disorders and feline urine spraying.
Tricyclic antidepressants (TCAs)
Indications:
Dose:
Contraindications and special notes
Treatment of anxiety-related behaviour problems in dogs and cats. Clomipramine is licensed for treatment of separation anxiety in dogs and indicated for urine spraying in cats and feline hyperaesthesia. It has also been advocated for the treatment of compulsive disorders in both dogs and cats. Amitriptyline is indicated for behavioural problems in cats secondary to idiopathic cystitis
CLOMIPRAMINE Dog: 1–3 mg/kg po q 12 hours Cat: 0.25–0.5 mg/kg po q 24 hours AMITRIPTYLINE Dog: 1–2 mg/kg po q 12 hours Cat: 0.5–1.0 mg/kg po q 24 hours DOXEPIN Dog: 3–5 mg/kg po q 12 hours Cat: 0.5–1.0 mg/kg po q 24 hours
May cause disinhibition of aggressive behaviour. Mild sedation is common in the first days of treatment and appears to be dose dependent. Therapeutic effects may not be seen for between 3 and 4 weeks after commencing treatment. Contraindicated in animals with urinary retention or any history of cardiac arrhythmias.
53
54
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Amitriptyline is also widely referenced in the literature and its use is specifically advocated in the treatment of behavioural consequences of idiopathic cystitis in cats. These include excessive grooming, particularly on the ventral abdomen and medial thighs, associated with the pain of the underlying medical condition and inappropriate urination which can result from negative associations between pain and litter facilities. On a practical note, administration of TCAs is usually in tablet form and some owners may experience difficulty when using fractions of tablets due to the bitter taste of the compound and the resulting hypersalivation in some individuals. In cats, where accurate dosing at relatively low levels is required, the use of a syrup form of clomipramine has proved to be beneficial (Table 6.3).
Selective serotonin re-uptake inhibitors (SSRIs) As their name suggests, these drugs differ from the TCAs in that they selectively block the re-uptake of serotonin and as a result are specifically recommended for the treatment of behavioural conditions which involve a component of impulsivity. The onset of action of the SSRIs is similar to the TCAs, with therapeutic effects being reported between 3 and 4 weeks after commencement of treatment. However, maximum therapeutic effect in cases of compulsive disorders may not be seen for as long as 8 weeks into the course of treatment. The most commonly used SSRIs in veterinary behavioural medicine are Fluoxetine, Sertraline and Fluvoxamine and the main canine indications for their use include compulsive disorders, anxiety-related competitive aggression and panic disorders in dogs. In cats, SSRIs have been advocated for the treatment of urine spraying and for compulsive disorders, but careful monitoring of elimination behaviour is recommended due to the risks of urinary retention and constipation.
Table 6.4
Reports of gastrointestinal side-effects in association with SSRI therapy are relatively common and can include inappetence, anorexia, diarrhoea and nausea. In order to reduce the risk of these effects it is recommended to administer a lower loading dose for 1 to 2 weeks before increasing to the relevant therapeutic dose. In contrast to the TCAs, cardiovascular side-effects are not reported with SSRIs (Table 6.4).
Monoamine oxidase inhibitors (MAOIs) In the field of veterinary behavioural medicine it is only the selective monoamine oxidase B inhibitors that are of clinical significance and selegiline is the only example of this drug class that is used for the treatment of behavioural disorders in companion animals. It carries a veterinary licence in a number of countries but the labelled indications vary. In the USA the product is licensed for the treatment of canine cognitive dysfunction while in the UK it carries a very broad licence advocating its use for the treatment of disorders of an emotional origin. Clinically, selegiline is used in a wide range of behavioural disorders including cases of canine fears and phobias and canine cognitive dysfunction. Research in the UK has suggested that the wideranging applications of this product may be the result of a dopamine-mediated increase in reward-motivated activity and a resulting enhancement of cognitive ability. Certainly, the action of selegiline is complex and, whilst inhibition of monoamine oxidase B activity is one of its main therapeutic actions, it is also reported to affect the metabolism of phenylethylamine, enhance the activity of the free radical scavenger superoxide dismutase and exert neuroprotective activity within the CNS. There are few reports of unwanted side-effects related to the administration of selegiline in dogs or cats, but combination therapy with other drug classes can result in very serious side-effects and should be avoided. In particular, administration with drugs acting on the serotonergic system, such as TCAs and SSRIs, can be associated with
Selective serotonin reuptake inhibitors (SSRIs)
Indications:
Dose:
Contraindications and special notes
Treatment of compulsive disorders and anxiety-related conditions in dogs and cats. Indicated in conditions of anxiety-related competitive aggression in dogs. Fluoxetine is indicated for treatment of urine spraying in cats
FLUOXETINE Dog: 0.5–1 mg/kg po q 24 hours Cat: 0.5–1 mg/kg po q 24 hours SERTRALINE Dog: 1–2 mg/kg po q 12 hours FLUVOXAMINE Dog: 1–2 mg/kg po q 12 hours
Careful monitoring is essential in cases involving canine aggression and advice should be given, related to the avoidance of any potential injury to individuals. Barrier methods such as muzzle training, appropriate restraint and careful supervision should be recommended. Therapeutic effects may not be seen for between 3 and 4 weeks after commencing treatment. A loading dose is recommended at the start of treatment in order to minimise gastrointestinal side-effects.
The role of pharmacology in behavioural medicine
Table 6.5
Monoamine oxidase B inhibitors
Indications:
Dose:
Contraindications and special notes
Treatment of behavioural problems of an emotional origin in dogs. Examples include fears and phobias. Treatment of age-related behavioural disorders in dogs and cats.
SELEGILINE Dog: 0.5 mg/kg q 24 hours Cat: 1.0 mg/kg q 24 hours
Do not administer in combination with serotonergic acting drugs such as TCAs and SSRIs or with phenothiazines, alpha-2 agonists or opiate analgesics. Do not administer to pregnant or lactating individuals. Therapeutic effects may not be seen for 6 weeks after commencing treatment for emotional disorders but onset of action is usually shorter in cases of cognitive dysfunction.
CNS toxicity and the onset of the potentially fatal condition serotonin syndrome and is therefore contraindicated. In addition, administration of phenothiazines, opiate analgesics and alpha-2 agonists is contraindicated in patients receiving selegiline. The use of selegiline in pregnant or lactating individuals is also prohibited (Table 6.5).
Beta-blockers The use of beta-blockers in the treatment of human anxietyrelated disorders is well-documented. In veterinary behavioural medicine their use is primarily related to the treatment of situation-specific anxieties in which somatic symptoms such as tachycardia and tachypnoea are preva-
Table 6.6
Beta-blockers Contraindications and special notes
Indications:
Dose:
Treatment of situational anxieties in dogs and cats.
PROPRANOLOL Contraindicated in Dog: 0.5–3.0 mg/kg q cases of cardiac 12 hours or as disease, hypotension required or bronchospasm. Cat: 0.2–1.0 mg/kg q Primarily used to deal 8 hours or as required with the somatic PINDOLOL effects of anxiety and Dog: 0.125–0.25 mg/kg q fear. 12 hours
Table 6.7
lent. Their use is contraindicated in animals with cardiac disease, hypotension or bronchospasm. The most commonly prescribed beta-blocker in behavioural medicine is propranolol but pindolol, which has a more significant effect on serotonin receptors, is also discussed in the literature. Since beta-blockers are most frequently used for situational conditions they are usually administered on an as-and-when basis. The animal should be in a relaxed state when the drug is given and treatment is therefore recommended before the anticipated situation occurs (Table 6.6).
Antiepileptics The use of anticonvulsant therapy within behavioural medicine is primarily indicated in those cases where epileptic activity is involved in the aetiology of the condition. Limbic or temporal lobe epilepsy has been implicated in cases of compulsive behaviour, such as tail-chasing, and in aggressive behaviour which was previously referred to as ‘rage syndrome’. Breed predispositions have been suggested in both cases, with the bull terrier breeds being over-represented in the tail-chasing cases and the solid-colour cocker spaniel being associated with aggressive responses related to limbic epilepsy. Monitoring of phenobarbitone medication in these cases should take the same form as in any neurological case, and combination with potassium bromide therapy (at neurological dose rates) may be considered beneficial in some cases. Collaboration between veterinary surgeons working in the fields of behaviour and neurology is recommended when assessing these cases.
Antiepileptics
Indications:
Dose:
Contraindications and special notes
Treatment of behavioural consequences of limbic epilepsy in dogs and cats. Carbamazepine has been indicated in cases of tail-chasing or spinning in dogs and cats as well as aggression in cats.
PHENOBARBITONE Dog: 1–8 mg/kg q 12 hours Cat: 1–2.5 mg/kg q 12 hours CARBAMAZEPINE Dog: 4–8 mg/kg q 12 hours Cat: 25 mg q 12 hours
Monitoring of therapeutic levels is important in successful use of phenobarbitone in these cases. Combination of phenobarbitone with KBr may be considered. Carbamazepine is contraindicated in cases of renal and hepatic impairment and in patients with cardiovascular or haematological disorders.
55
56
BASIC TOOLS IN BEHAVIOURAL MEDICINE
The use of carbamazepine has been recommended in dogs for cases of tail-chasing or spinning which are attributable to limbic epilepsy, and in cats for cases of spontaneous aggression (Table 6.7).
Central nervous system (CNS) stimulants Clinical use of CNS stimulants is limited to the diagnosis and treatment of hyperkinesis, which is a rare condition in companion animals. The diagnostic role of these substances stems from the paradoxical decrease in heart rate, respiratory rate and activity level which occurs following their administration to individuals suffering from hyperkinesis. (The response to such therapy in non-affected individuals would be a significant increase in all of these parameters). Treatment with CNS stimulants may also be indicated in cases of narcolepsy, but this is also a rare condition in companion animals and would be most likely to be diagnosed after specialist intervention (Table 6.8).
Hormonal preparations While the use of progestogens and anti-androgens may have decreased in recent years for the reasons outlined later in this section, one product with hormonal activity which is proving to be beneficial to the field of behavioural medicine is cabergoline. This drug is a dopamine2-receptor agonist which has antiprolactin effects and is recommended for the treatment of pseudopregnancy in bitches. This condition does not only present with a set of physical symptoms but may also result in purely behavioural changes, such as aggression toward family members or other household pets and therefore cabergoline has become an important drug in behavioural prac-
tice. The onset of aggressive behaviour in bitches post spaying may in some cases be attributable to elevated prolactin levels following surgery and treatment with cabergoline can be dramatically effective in these cases. The literature also suggests that cabergoline may be of some benefit in the treatment of psychotic behaviour and reward-deficiency syndromes; therefore, its applications in the field of behavioural medicine may be wider than first thought (Table 6.9). Progestogens were among the first drugs to include any mention of behavioural disorders in their list of indications but their effects in these situations were non-specific and, while much was written about their hormonal effects, their tranquillizing effects through central steroid receptors were largely overlooked. However, it is likely that these central calming effects were primarily responsible for their apparent success and the non-specific nature of their action, combined with the potential for extensive and frequent side-effects, has led to their being replaced with more specific psychoactive medications. Treatment with progestogens as a first-line therapy in behavioural medicine is no longer recommended. Anti-androgens do continue to be used in order to chemically mimic castration when owners are considering surgery as a treatment option. The drug most commonly used is delmadinone acetate and dose rates are in line with data sheet recommendations. While its use may be beneficial, it is important for owners to appreciate that delmadinone does give some central calming effect in addition to its direct hormonal action and therefore it does not entirely mimic the surgical process. Cases in which delmadinone resulted in a significant alteration in the behavioural signs but surgery did not maintain those benefits have, therefore, been reported.
Table 6.9 Table 6.8
Dopamine 2 receptor agonists
CNS stimulants
Indications:
Dose:
Diagnosis and treatment of hyperkinesis.
DEXTROAMPHETAMINE Dog: 0.2–1.3 mg/kg po as a diagnostic tool – heart rate, respiratory rate and activity level to be monitored every 30 minutes for 1–2 hours following administration METHYLPHENIDATE 2–4 mg/kg q 8–12 hours as a therapeutic dose
Contraindications and special notes Hyperkinesis and narcolepsy are both rare conditions. The use of CNS stimulants is therefore extremely limited.
Indications:
Dose:
Treatment of behavioural consequences of pseudopregnancy and behavioural changes post spaying in bitches.
CABERGOLINE Dog: 5 mg/kg q 24 hours for 5–14 days
Contraindications and special notes Although the data sheet recommendation is for 5 days of therapy with cabergoline, clinical experience suggests that courses of up to 14 days may be necessary in cases of maternal aggression or other behavioural problems relating to persistently high prolactin levels.
The role of pharmacology in behavioural medicine
Antihistamines
Table 6.11
Although the primary indications of this drug class are not behavioural, they are nonetheless considered to be useful in the management of mild anxiety associated with car travel, as well as inappropriate night time activity and anxiety conditions in which pruritus plays a role. In these situations their sedative CNS side-effects are being exploited for their behavioural benefit. Antihistamines are contraindicated in animals suffering from glaucoma, urinary retention or hyperthyroidism and owners need to be warned of possible anticholinergic side-effects such as dry mouth or constipation. Cyproheptadine is an antihistamine with significant serotoninergic antagonist activity and has been advocated as an appetite stimulant in both cats and dogs (Table 6.10).
Alpha-adrenoreceptor stimulants These drugs do not have a direct behavioural indication but phenylpropanolamine is commonly used in the treatment of sphincter mechanism incompetence in bitches and can therefore form part of the therapeutic approach to house-soiling in these cases. In addition, there are reports in the literature of its use in cases of submissive or excitement-related urine leaking. Increased aggression is a possible side-effect of its use and owners need to be informed of this risk before treatment commences (Table 6.11).
Alpha-adrenoreceptor antagonists Nicergoline is advocated as a treatment for age-related behaviour changes such as sleep disorders, diminished vigour and fatigue. It acts as a cerebral vasodilator, thereby increasing blood flow to the brain and assisting in reversal
Table 6.10
Antihistamines
Indications:
Dose:
Treatment of mild anxiety associated with car travel, night time activity and excessive vocalisation. Indicated for mild anxiety conditions with an element of pruritus.
CHLORPHENIRAMINE Dog: 220 micrograms/kg q 8 hours (Max 1 mg/kg in 24 hours) Cat: 1–2 mg/kg q 8–12 hours DIPHENHYDRAMINE Dog and cat: 2–4 mg/kg q 8–12 hours CYPROHEPTADINE Dog and cat: 0.1–0.5 mg/kg q 8–12 hours
Alpha-adrenoreceptor stimulants
Indications:
Dose:
Contraindications and special notes
Treatment of sphincter mechanism incompetence and resulting issues of house soiling.
PHENYLPROPANOLAMINE Dog: 1.1–4.4 mg/kg q 8–12 hours Cat: 1.0–1.5 mg/kg q 12 hours
Owners need to be informed of the risk of aggression as a side-effect of treatment.
of chronic hypoxia, which is implicated in the aetiology of these behaviour changes. In addition, it is reported to act as a cognitive enhancer by reversing the vasoconstrictive effect of cerebral catecholamines, to exert neuroprotective action on neural cells and to have both serotonergic and dopaminergic action. Concurrent use of other vasodilators may cause hypotension and nicergoline should not be administered within 24 hours of using alpha 2 agonists such as xylazine or metetomidine (Table 6.12).
Xanthine derivatives Propentofylline is licensed for the treatment of canine agerelated behaviour changes such as dullness and lethargy. In addition to improving cerebral blood flow through vasodilation, xanthine derivatives also improve cerebral metabolism through neuroprotective functions. Other important functions of propentofylline are its action as a glial cell modifier and its role in increasing levels of adenosine. In long-standing cases of canine cognitive decline it has been reported that the effects of single-drug therapy may not be sustained and that such cases may respond better to combination therapy with selegiline and propentofylline (Table 6.13).
Contraindications and special notes Not to be used in patients suffering from glaucoma, urinary retention or hyperthyroidism.
Table 6.12
Alpha-adrenoreceptor antagonists
Indications:
Dose:
Treatment of agerelated behaviour changes in dogs.
NICERGOLINE Dog: 250–500 μg/kg q 24 hours administered in the morning
Contraindications and special notes Concurrent use of other vasodilators can cause hypotension. Do not administer within 24 hours of using alpha 2 agonists.
57
58
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Table 6.13
Xanthine derivatives
Indications:
Dose:
Treatment of PROPENTOFYLLINE age-related Dog: behaviour changes 2.5–5 mg/kg q in dogs. 12 hours
areas because the evaporation of the alcohol carrier can be disturbing for some cats. Contraindications and special notes In advanced or long-standing cases of canine cognitive dysfunction combination therapy with selegiline is recommended.
Pheromonotherapy (as an adjunct to behavioural therapy) One major development in therapeutic approaches to behavioural disorders in recent years has been increasing interest in the application of so-called pheromonotherapy into the field of companion animal behaviour therapy and there are now three versions of commercial ‘pheromones’ available for use in veterinary practice in the UK. Two fractions (F3 or Feline Facial Pheromone Analogue – FFP and F4) are used in the cat for the management of a range of behaviour problems and there is also one canine pheromone now available (Dog Appeasing Pheromone – DAP®). Depending on the formulation, pheromones have the potential to be applied to physical objects in the environment, aerially through diffusion or directly as a spray application onto the animal or onto human hands.
Feliway® Feliway® (CEVA Animal Health) is known as the ‘familiarisation pheromone’ and it is believed to provide a feeling of security for cats in unfamiliar or stressful situations. It is a synthetic analogue of the F3 fraction of the so-called ‘feline facial pheromone’. Its applications reflect this belief, although the exact mode of action is as yet unclear. Feliway® is indicated for the management of indoor urine spraying, inappropriate scratching behaviour, problems during transportation and behavioural changes associated with being confined in a cattery or veterinary hospital situation. In addition, reports from those working in the field of companion animal behaviour have shown that Feliway® can be beneficial in cases of inter-cat tension in the household and in a range of feline behavioural signs which accompany high levels of unsolved stress for the cat, such as overgrooming. Within a veterinary context it can be beneficial in the consulting room environment and also in the area used for presurgical preparation and anaesthesia induction. Feliway® is an environmental product and is available both as a diffuser and as a spray. The spray needs to be applied 30 minutes before cats are allowed access to treated
Felifriend® Felifriend® (CEVA Animal Health) is a synthetic analogue of the F4 fraction of the ‘feline facial’ pheromone and is believed to assist in the development of an atmosphere of confidence between cats and unfamiliar people. Felifriend® is applied to the palms of each hand and is rubbed over the hands and wrists of the handler. It is marketed specifically for use in the veterinary consulting room where it is believed to reduce the cat’s anxiety. It has been advocated for use with particularly fractious cats during consultation and at other times of restraint. In studies, the use of Felifriend® has significantly reduced the major signs of aggression during consultations, including attempts to bite and scratch the handler. In France, Felifriend® is also marketed for use in cases of aggression between cats in the same household and in these cases it is applied to the neck and flank region of each cat. In some cases Felifriend® has been found to induce what appears to be a panic reaction; it is suggested that this is most likely to occur when the cat is faced with a human or feline who is already strongly associated with hostility and therefore the visual signal of threat is in direct contradiction to the appeasing scent signal. The best results are obtained when the person or cat is totally unknown or where inter-cat aggression is in its early stages.
Dog Appeasing Pheromone A recent addition to the commercially available pheromone products has been Dog Appeasing Pheromone or DAP®. This product is available in the UK as a diffuser application and one bottle is recommended to last for a period of 1 month. Refills can be purchased and applied to the original diffuser device. A DAP® spray is also available. The product is based on a synthetic analogue of a scent signal which emanates from the inter-mammary sulcus of the lactating bitch. At this stage of puppy development the scent appears to be important in promoting calm and secure behaviour and in establishing a bond with the mother. The anxiety-reducing properties of this substance affect the adult dog’s behaviour, and the applications of DAP® are varied. It has been specifically advocated in a prophylactic role for assisting young puppies in settling into their new homes and for a wide range of situations that generate fear and distress reactions, such as separation from the owner. It has also been found to be extremely effective as part of the approach to fear-related behaviours in dogs including sound sensitivity and fear of noises, such as fireworks and thunder. In such cases DAP® is recommended as an adjunct to a specially designed desensitisation and counterconditioning programme.
59
Chapter 7
Geriatric behavioural issues
CHAPTER CONTENTS Introduction 59 Incidence of behavioural problems 59 Medical issues 60 Management of ageing dogs and cats 62 Cognitive impairment 63 Pseudodementia 63 Vascular dementia 64 Dementia of Alzheimer type (DAT) 64 Cognitive dementia in the dog and cat (Alzheimer-like) 65 Diagnosis 65 Treatment 66 Dietary modification 66 Drug therapy 67 Behavioural therapy 68 Prognosis 69 Advice sheets that may be relevant to this chapter 69
INTRODUCTION The rate of ageing varies with breed such that in the larger dog breeds, individuals may be considered to be geriatric at as young as 7 years of age. The corollary of this is that dogs physically age at around 1 year for every two calendar months. During the last third of the life span there is increased risk of serious or debilitating degenerative disease. Similarly, accelerated ageing is seen in cats and the combined effect is that, from the owner’s perspective, a pet’s health appears to decline very suddenly and rapidly. Degenerative disease processes have a better prognosis if they are diagnosed and treated at the earliest possible stage. Even a thorough annual physical examination cannot accomplish this and so owners need to be made aware of all warning signs of changes in health and encouraged to seek help quickly.
INCIDENCE OF BEHAVIOURAL PROBLEMS Behavioural problems are generally less common within the elderly dog and cat populations. The incidence of individual problem types within this population is also different (Table 7.1). There is a combination of reasons for these differences: ●
●
●
Many behavioural problems have a peak incidence that is before 3 to 4 years of age. These early problems will either be resolved, or the owner has adapted to them by the time the dog or cat has aged. The more seriously affected dogs and cats have been euthanised before they reach old age.
However, there are other reasons for an under-presentation of behaviour problems in older dogs: ●
●
Owners believe that the problems they see are an untreatable, normal part of the ageing process. Owners are fearful of mentioning problems that may be seen as serious and a potential indication for euthanasia.
60
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Table 7.1 Incidence of behavioural problems in the geriatric population Increased incidence
Decreased incidence
Fear and anxiety-related: ● ‘Stereotypy/compulsive’ ● Separation-related ● Destructiveness ● Phobia Vocalisation House soiling Sleep disturbance
type and an individual geriatric dog or cat may have a number of concurrent diseases and debilities. The relationship between common clinical signs, associated medical causes and behavioural signs is set out in Table 7.3. There are a number of reasons why this is important: ●
●
Aggression Over activity
Thus behavioural problems may be under-presented in the older dog and cat populations (Table 7.2).
●
MEDICAL ISSUES The latter third of life is a peak risk period for many of the medical disorders that we know are implicated in problem behaviour. Many of these diseases are of a degenerative
Table 7.2
●
Pain or debilitation-related irritability and selfdefensiveness might cause the animal to lash out with a scratch, snap or bite in situations where it would otherwise give a warning or move away. Animals that have impaired senses, physical debilitation or suffer pain may not be able to mount a proper escape or avoidance reaction in situations where they are frightened. If they are not able to anticipate and avoid a situation then they may become more fearful or aggressive. If there is competition or a hierarchical dispute between dogs in a household, then the sensory or physically impaired dog may be injured because it is not able to react appropriately. The welfare of the aged animal is a concern because the programme of behavioural modification may cause further pain and stress.
Behavioural problems and their causes in the geriatric dog and cat
Behaviour
Motivation/explanation
Aggression
Resource control (e.g., secondary to metabolic disease) Increased fear Poor communication with, or awareness of conspecifics (leading to status conflict in dogs, or reduced avoidance in cats and dogs)
Excess vocalisation
Loss of reassuring presence of a familiar person Insecurity in environment Increased fearful reaction to stimuli (e.g., loud or unfamiliar noises)
Destructiveness
Escape from fear-eliciting stimuli Attempt to reunite with owner (dog) Self-appeasement chewing
Waking at night (often combined with vocalisation and increased activity)
Disorientation upon waking: ● cognitive or sensory impairment Day–night reversal of sleep pattern due to lack of day time stimulation/activity
Stereotypic/compulsive behaviour
Self-mutilation, pacing/circling ● anxiety/stress (oral displacement/self-appeasement) ● self-appeasement during pain ● confusion, cognitive impairment
Noise phobias
Increased fearfulness/anxiety Cognitive impairment Sensory impairment Debilitation of avoidance/coping strategies
Separation-related
Loss of reassuring presence of owner (e.g., cognitively impaired dog) Loss of owner influence over behaviour
Geriatric behavioural issues
Table 7.3
Relationship between clinical signs, potential medical causes and behavioural signs
Clinical sign
Potential medical causes
Behavioural signs
Polyuria/Polydipsia
Renal disease Hepatic disease Diabetes insipidus Metabolic disease: ● Cushing’s syndrome ● Diabetes mellitus
House-soiling (increased frequency and urgency of urination) Increased competition for food bowl
Pain
Musculoskeletal Dental Abdominal: ● Pancreatitis ● Faecal impaction Anal gland impaction
Increased aggressiveness Irritability Loss of mobility Loss of play and interaction Increased anxiety and fear Sleep disturbance
Sensory loss
Blindness Deafness Proprioceptive loss Loss of olfaction
Reduced ability to navigate environment Hypersensitivity to unimpaired sensory modalities Impaired communication Impaired avoidance behaviour
Exercise intolerance
Cellular hypoxia: ● Cardiovascular disease ● Anaemia ● Respiratory disease Obesity Disuse atrophy of skeletal muscle
Impaired avoidance behaviour Worsening phobia Aggression (self-defence) Irritability Frustration Inability to carry out normal behaviour
Polyphagia
Metabolic disease: ● Cushing’s syndrome ● Diabetes mellitus ● Hyperthyroidism (cat)
Increased competition for resources Food guarding Food stealing Aggression around food
Problems of urinary outflow control
Prostatic disease (obstruction) Urinary incontinence
House-soiling
Dullness/Impaired cognition
Hypothyroidism Reduced cerebral oxygenation (cardiac/pulmonary/vascular disease)
Confusion Anxiety Loss of interaction and communication
●
Cognitively impaired animals are likely to be more anxious or fearful and less able to cope with novel experiences. They may react abruptly, without warning and with little self-control or social inhibition (learned response to the social constraints of the group).
The effect is that new behavioural problems may develop in old age, or problems that were thought resolved or tolerable become more severe and unmanageable. Unfortunately, there is a tendency for mild clinical signs to be disregarded as an inevitable part of ageing. The prevalence of this attitude is borne out in studies of patterns of investigation of clinical signs in young and aged dogs. It has been shown that clinicians offer completely different services to the two age groups. For example, a lame young dog was several times more likely to be radi-
ographed than an older one with matching symptoms. The older dog was more likely to be given symptomatic treatment on the assumption that it was suffering from degenerative joint disease. Once treated, older dogs were offered far fewer treatment reviews and changes of medication. Owners more frequently accepted symptomatic management in place of investigation. This is in direct contradiction to known data on incidence of serious disease in the two populations, and highlights the obvious need to continually review efficacy of treatment. All medical problems should be resolved or managed as effectively as possible before a behavioural assessment is carried out: ● ●
Full clinical examination Comprehensive haematology and biochemistry
61
62
BASIC TOOLS IN BEHAVIOURAL MEDICINE
●
●
Complete review of the effectiveness of current medical treatments Assessment of effectiveness of current pain management
Table 7.4
Coping with sensory loss
Loss of vision
If anything, it should be assumed that the elderly dog has medical issues that will affect its behaviour unless it is proven to the contrary.
Provide extra cues that enable the pet to navigate the environment: ●
●
MANAGEMENT OF AGEING DOGS AND CATS Sensory loss and debilitation are common in the elderly population and adaptations need to be made if they are to be supported. As mentioned later in this chapter, debilitated animals that become inactive are likely to become progressively less healthy. If given appropriate stimulation and interaction these animals can enjoy a comparatively good quality of life. Sensory loss, such as blindness or deafness, are common in the geriatric dog or cat and owners can do a great deal to make these pets’ lives easier. Animals can be provided with additional environmental cues that help them to find their way around and get to resources and resting places. This reduces stress and avoids complications such as dehydration. Elderly pets with mobility problems, and those with painful conditions such as osteoarthritis, may show a significant improvement in well-being if given easy access to resources close to where they spend time during the day (Fig. 7.1, Table 7.4). Exercise patterns may need to change if an older dog is unable to cope with long walks. It has to be remembered that dogs are highly social and benefit from mental stimulation. For the older dog, walks should be made shorter but more frequent and more stimulating. The dog should be taken regularly to a park where it can spend time with other dogs, or to new places which it can investigate.
●
Tactile: textured rugs in the middle of corridors and the centre of rooms to guide the dog away from furniture. Audible: leave radios playing different stations in different rooms. Place them at floor level so that the dog can ‘hear’ where furniture is positioned (objects block sound waves) or place them next to specific resource such as food and water bowls. Odor: use room fragrancers to identify different rooms. Perhaps use an odour such as lavender oil to identify the dog’s bed.
Avoid making significant changes in room or garden layout so that the pet is not confused. Announce all interactions by calling the pet to avoid startling and frightening it. For dogs, all walks should be on an extending leash. Hearing loss
Try to make eye contact before interactions to avoid startling the pet. Condition the pet to anticipate interaction and reward (food treat) when touched on a particular part of the body away from the head. Train recall, sit and other signals using hand signals. Off-leash control may be improved using a remoteactivated vibrating collar (not a gas or shock collar). The dog is trained to look for the owner when the vibration is felt, which then makes other commands such as recall easier.
Minimal load exercise, such as swimming, is an excellent way to maintain general fitness and muscle mass without damaging already painful joints. If other dogs are present, swimming may be an ideal opportunity to enjoy much less restricted play. Elderly cats may derive pleasure from brief games or watching other animals play. Obesity is a major problem in elderly dogs and some cats and owners should be encouraged to feed older animals on a nutrient-rich low calorie diet to avoid weight gain as the animal becomes less active. Activity feeding, such as the use of an activity ball or scattering food on the garden for a dog to find, or the use of small activity balls for cats, are excellent ways to increase an individual’s energy expenditure and avoid weight gain (Fig. 7.2).
Managing the care of older pets Figure 7.1 It is important to provide geriatric dogs with easy access to resources such as fresh water.
Most practices will have a large cohort of older dogs and cats that will at some time need ‘geriatric care’. As mentioned previously, these pets may start to become ill and
Geriatric behavioural issues
Figure 7.2 Activity feeders provide geriatric animals with mental and physical stimulation, but must be not be difficult to use or they may cause stress and anxiety.
enter a state of decline between the conventional annual health checks. Behavioural assessment is, in any case, often missed out of annual checks on the grounds of time and complexity (Box 7.1).
Box 7.1 Suggested methods for improving care for impending geriatric cases ●
●
● ●
Regular planned reviews of pain control and disease management. 6-monthly (or more frequent) nurse appointments to follow through a checklist of behavioural and general health indicators. Regular weighing (good indicator of reducing activity). Provide owners with a basic questionnaire on behaviour and general health, to be completed in advance of all health checks.
COGNITIVE IMPAIRMENT The signs of cognitive impairment will often precede other organic signs of ageing and are a good indicator of general health. Thus, behavioural change may be the first indicator of the need to intervene more widely in the health of the geriatric dog. Owners should be made aware of the mildest signs of this condition so that they bring affected dogs for treatment at the earliest possible stage. It is vital that the signs of cognitive impairment are not taken for natural signs of old age. Cognitive impairment in cats often goes entirely unnoticed because the major part of the cat’s activity pattern
occurs outside the home. Reductions in hunting, territorial activity and other outdoor activity are often missed. Owners merely report that the cat spends more time at home or asleep. There may be increases in vocalisation, anxiety and dependence. Cognitive impairment is a serious problem, indeed it is a life-threatening disease for many elderly dogs. Owners are not aware that in early cases the signs of impairment are treatable or temporarily reversible, so they may not bring these cases to the clinic until they have progressed too far. Loss of activity and normal interaction with the owner impairs the human–animal bond so that when the dog begins to disturb the owner’s sleep, bark incessantly or soil in the house, it is more likely that owners will bring the animal to the clinic for euthanasia. So, for the sake of the pet’s health and welfare, we need to encourage owners to discuss subtle changes in the behaviour of their ageing pet. Certain forms of human and animal cognitive dementia share similarities and it is worth comparing them. Human age-related dementia is subdivided into numerous categories. The three commonest forms are: ● ● ●
Pseudodementia Vascular dementia Dementia of the Alzheimer type (DAT)
PSEUDODEMENTIA Pseudodementia is a type of depression seen in elderly human patients. Signs are typical of other forms of depression but this condition is often confused with true dementia because of the complicating effects of the specific forms of debilitation that accompany old age. There is a general
63
64
BASIC TOOLS IN BEHAVIOURAL MEDICINE
reduction in activity and social interaction, and a loss of interest in occupations the individual formerly found pleasurable. There may be memory loss, anxiety, and other complications that follow from depression. Pseudodementia generally arises out of debilitations that interfere with the individual’s ability to carry out normal activities. For example, the degradation of vision, hearing or mobility. Without the mental stimulation of regular communication, activity and involvement with the environment, the individual becomes withdrawn, frustrated and anxious. In man it has been shown that pseudodementia is entirely reversible and does not appear to be associated with any histopathological changes. However, the condition may be made worse by the onset of the gradual depletion of neurotransmitter function that occurs with age. There is no recognised equivalent diagnosis to pseudodementia in the dog or cat, but the factors that create pseudodementia in man are present in the canine and feline populations too and there is every reason to think that many elderly animals suffer from an analogous condition. To recognise the potential for pseudodementia is important because it contributes to a general decline in physical and mental health. For example, in man pseudodementia is a risk factor for developing other more serious forms of dementia. Individuals that become depressed as a result of debilitation will suffer a more rapid decline in fitness and general health. Human sufferers of pseudodementia respond very rapidly to basic rehabilitation; better pain management, treatment of debilitating disease and the provision of stimulating activities that are within the capabilities of the individual. Precisely the same approach should be used in older dogs and cats that have no specific cognitive impairments but are generally depressed in mood.
of such drugs in treating canine dementia is not an indication that canine patients share identical pathology with human vascular dementia sufferers.
DEMENTIA ALZHEIMER TYPE (DAT) Dementia of the Alzheimer type is the commonest form of dementia in man. The pathology and pathophysiology are relatively well-described and broadly similar to that seen in cognitive dementia in dogs. A simplified description of the changes seen in both dog and man are listed below: ●
●
●
●
●
●
●
●
VASCULAR DEMENTIA Vascular dementia and dementia of the Alzheimer type (DAT) are the commonest forms of dementia in man. Vascular dementia results from poor oxygenation of the brain due to circulatory impairment. There are probably numerous types of this condition, resulting from different patterns of cerebrovascular obstruction, including infarcts and emboli. Risk factors in man include atherosclerosis, hypertension, cardiac arrhythmia, diabetes mellitus and hyperlipidaemia. Some of these factors are also common in the canine and feline population and cases of dementia relating to a primary cerebrovascular defect are probably also common. To identify and resolve treatable causes of vascular dementia is important because these animals will only obtain limited benefit from drug and dietary treatments intended for Alzheimer type dementia. Drugs such as propentofylline are being licensed for the treatment of human vascular dementia and also for the treatment of cognitive decline in the dog. However, the general success
●
●
Mitochondrial metabolism becomes defective producing more metabolic waste (free radicals) per unit of energy. Antioxidant mechanisms that normally defend tissues against oxidative damage are overwhelmed by the excess production of free radicals. Repair processes are ineffective because there is insufficient energy production to fuel both maintenance and repair. The oxidation of lipid and protein components leads to cellular damage and increased production of betaamyloid. Beta-amyloid and lipid peroxides are themselves neurotoxic and so a spiral of cellular damage begins. Histologically, there is deposition of beta-amyloid in microscopic plaques, beginning in the frontal cortex and sweeping rearwards throughout the cerebrum, leading to a characteristic progression of symptoms. Beta-amyloid is also deposited in vital structures such as the hippocampus (responsible for short-term memory formation). The situation is further complicated by the fact that beta-amyloid provokes an inflammatory response which further interferes with local nerve function; and the histological changes extend to damage to the microcirculation of the brain so that oxygenation of tissues is reduced. A vicious cycle of degeneration and increasing betaamyloid deposition will develop. There is also accompanying reduction in neurotransmitter production and recycling.
The severity of dementia in both dog and man correlates very strongly with the quantity of beta-amyloid present in the brain. It is probable that a similar process is present in the cat. This process of degeneration can be divided into two phases. During the first (initiation) phase there is a general impairment of neurological functioning due to neurotransmitter depletion, cellular metabolic disturbance and oxidation, but the amount of beta-amyloid is quite low. In the second phase, significant quantities of beta-amyloid have been deposited. The effects of oxidation and toxicity of oxidised cellular components creates a spiral of damage that is more rapid and irreversible.
Geriatric behavioural issues
Beta-amyloid and tau protein are seen in the plaques of feline, canine and human patients, but the organisation and distribution are different. In man, the beta-amyloid plaques are quite large and focal. Tau protein forms ‘tangles’ that are a microscopically visible component of each plaque. In the dog, the beta-amyloid plaques are smaller and more diffusely distributed within the brain. Tau protein is chemically detectable in the plaques but does not form large tangles. Cats also have large and focal plaques which otherwise biochemically resemble those in the dog. Larger plaques are associated with more severe and permanent local neurological impairment. These histologically observed differences in pathology appear to be important for the differing progression and progress of the disease in the three species. In man, the damage caused is apparently permanent and irreparable; no treatments have as yet significantly delayed or reversed any signs of human DAT. In dogs, the outlook is more positive. Behavioural signs of dementia are often temporarily reversible and the progress of the disease can be dramatically slowed down. In humans, no matter how aggressively it is treated, this disease is the primary life-threatening condition. Dogs have a much better prognosis because, if treated at a sufficiently early stage, the progression of the condition can be slowed to a point that other medical disorders are likely to replace dementia as the life-limiting condition. The outlook for feline patients is uncertain, but the size of plaques and general lateness of diagnosis mean that the prognosis is less good than for the dog. It may be that the more diffuse beta-amyloid in the canine patient causes less severe damage and allows for more gradual remodelling so that function is taken up by other nervous tissue. Alternatively, the different role of tau protein in human beta-amyloid plaques may be relevant. Certainly, the functional demands on the canine brain are substantially less than those on the human so the dog is able to appear relatively normal, even when severe impairments are present.
COGNITIVE DEMENTIA IN THE DOG AND CAT (ALZHEIMER-LIKE) DIAGNOSIS This form of dementia closely mirrors DAT in terms of clinical effects and pathology (see above). Early diagnosis is critical. To treat these cases effectively, we must intervene during the earliest stages of the disease when damage is less critical; for example, during the first phase of impairment. Behavioural changes in early dementia are quite subtle and easily confused with depression and the effects of illness. Many owners write them off as ‘just old age’. In the early stages of dementia we might typically see quite nondescript signs that are often hard to attribute to any specific cause:
● ● ● ● ● ●
lethargy and depression reduced activity reduced social interaction loss of play mild disturbance of sleep pattern mild increases in fear and anxiety.
These changes are linked to the initiation phase of the condition, so it is particularly important to catch cases at this stage. There will be mild cognitive impairment and these dogs can be differentiated from ones with debilitation and depression by the lack of response to improved medical management and environmental stimulation. As the disorder progresses, more severe signs emerge that are linked to five underlying degenerative processes: 1. Generalised and localised cortical impairment (frontal cortex, motor cortex, etc): ● changes of ‘personality’ ● confusion and failure to interpret sensory information correctly (staring into space or at inanimate objects) 2. Loss of learned behaviours: ● house-training ● control commands ● social inhibition (ignorance of the restraining influence of the presence of other individuals, including the owner) ● food snatching and stealing in front of the owner ● elimination in front of owner 3. Changes in emotionality: ● worsening of existing fear and phobia problems ● increased anxiety ● depression ● irritability 4. Impaired ability to form new short-term memory: ● repetition of behaviour (e.g., requests for attention, food, or to go outside) ● difficulty acquiring new learning (e.g., being housetrained again) 5. Specific neurological impairments: ● loss of proprioception ● sensory impairment (central blindness, central deafness)
The mixture of symptoms seen in any individual case is quite unique. A large proportion of the animal’s consistent pattern of responses that we might call ‘personality’ is learned during life. In particular, this includes patterns of social inhibition in which the animal learns to suppress highly motivated behaviour according to the social context. For example, many young dogs will try to snatch food from the plate of a person or another animal, but they rapidly learn that this is unacceptable. Likewise, an attentionseeking dog learns not to pester its owner. Dogs with dementia lose these inhibitions and may return to acting purely on current motivation. Punishment, including ignoring behaviour, has little or no effect other than to distress the animal and risk conflict with it.
65
66
BASIC TOOLS IN BEHAVIOURAL MEDICINE
Despite the fact that a decline in interaction is often cited as an indication of dementia, this is not always the case. In some individuals the level of attention-seeking increases. There are many reasons for this; for example, if the animal’s level of anxiety forces it to demand more reassurance from its owner or because it still feels hungry and cannot remember when it last asked for food. So it is best to remember the underlying factors in dementia-related behavioural change and then to use them to interpret the animal’s current behaviour. As the condition progresses further, there is an accumulation of damage in specific areas leading to discrete neurological signs such as ataxia, central blindness or deafness. These sensory losses are often confused with actual primary sensory loss, especially in dogs with already limited vision. Usually an examination will reveal that the animal’s actual hearing or vision loss is not enough to account for the overall sensory impairment. In these cases, it is damage to the CNS which is leading to the loss of functional vision or hearing because the animal is not able to process and interpret the sensory information it is getting. Even at this advanced stage there is some value in treatment. It is relatively easy to pick up moderately severe cases, but early and severe ones are more difficult. The former because owners may assume that what they are seeing is the effect of normal ageing, the latter because the more obvious signs of cognitive dementia are obscured by severe neurological signs.
Table 7.5
Veterinary procedures and environments Event
Effect
Veterinary procedures
Anaesthesia/sedation Surgery Medication Examination
Hypoxia, hypovolaemia, low blood pressure, after-effects of drugs Blood loss e.g., steroids, tranquillisers Emotional and physical stress, fear, anxiety
Change to a new environment
Hospitalization Kennelling House move
Loss of familiar cues that enable animal to comprehend environment Emotional stress
Alterations to New pets current environment Children Change of owner routine
Changes in status (dog), competition for resources (food, attention) Loss of owner attention, unfamiliar noises/activities Loss of reassuring presence of owner
TREATMENT
High-risk periods for the geriatric pet Certain events are known to place additional stress on patients and represent a unique risk to the cognitively impaired pet (Table 7.5). Preparations can be made for these events so that their impact is minimised. For example, using dietary modification and the administration of psychoactive, antioxidant or neuroprotective drugs in advance of planned events, such as general anaesthesia. Pre-operative blood screening, together with continuous intra-operative and recovery blood pressure and oximetry measurement, are essential for proper anaesthetic management. Wherever possible perioperative pain relief should be used to reduce the uncomfortable after-effects of prolonged recumbency, and reversible or short-acting sedatives and induction agents should be used so that anaesthetic duration is minimised. The animal should be returned to a familiar environment as soon as safely possible after recovery. In the dog, Dog Appeasing Pheromone (DAP®) can be used to aid familiarisation with new environments. For example, if a DAP® diffuser is installed in the dog’s home a few days prior to a change of environment, then the new environment will seem more familiar and less threatening if a DAP® is installed there too. This effect can be used to reduce stress for older animals that are to be hospitalised or come to the clinic for procedures.
Treatment should have several aims: ● ●
● ●
Delay progression of disease (where possible). Return mental function to a level at which normal behaviour may be re-established. Retrain lost behaviour. Re-establish relationships with people and other animals in the house so that social support helps to maintain improvement
The treatable underlying mechanisms of cognitive dementia are: ● ● ●
● ●
depletion of neurotransmitter function localised inflammation around beta-amyloid plaques mitochondrial inefficiency (producing more free radicals per unit of useable energy) depletion of cytochemicals needed for cell repair ongoing oxidative damage.
There are several approaches to correcting these faults which may be used in combination with each other.
Dietary modification There is considerable evidence that dietary supplementation can be used to improve mitochondrial metabolic function and assist oxygen free-radical scavenging mechanisms.
Geriatric behavioural issues
Trials also suggest that these supplements are equally effective in vivo, improving neuronal metabolic function and boosting CNS antioxidant reserve. Supplements with demonstrable efficacy include vitamin E, n-acetyl-l-carnitine and alpha-lipoic acid which have been trialled in a number of species, but most specialist diets also include a range of other antioxidant chemicals and additives. The diet should also include increased levels of cellular repair materials such as essential fatty acids. Low protein, high carbohydrate diets made with high-quality protein and vitamin B supplementation can be used to increase the levels of the neurotransmitter serotonin (5-HT), which may be useful in dogs that are suffering from chronic anxiety. Of course, such diets must also be compatible with whatever medical problems the animal is also experiencing, but most senior and disease specific diets can be modified easily and safely to give benefits to the cognitively impaired animal. Dietary modification of this kind should be the mainstay therapy to delay progression of dementia and should be instituted in dogs with the earliest signs of dementia. Owners can expect to see improvements within 4 to 6 weeks of dietary change. Dietary modification is also potentially useful for senile cats, but early intervention is even more important.
Drug therapy In behavioural medicine, psychoactive drugs are primarily used to correct neurotransmitter abnormalities, but some of these drugs have specific properties that may be useful for the cognitively impaired dog or cat. Drugs such as propentofylline and nicergoline have specific effects on cerebral circulation in the dog. Drugs should be carefully selected to complement dietary modification in line with anticipated neurotransmitter problems or cerebral oxygenation/perfusion problems. Where cerebral oxygenation is an issue, all efforts should be made to correct any cardiovascular or pulmonary problems that may be the root cause.
Table 7.6
Drug therapy: effects and drug types
Effect
Drug types
Improve cerebral circulation
Propentofylline Nicergoline Selegiline Propentofylline Nicergoline
Antioxidant effects
Improve neurotransmitter function Dopamine Serotonin Neuroprotective effects
Selegiline Clomipramine Selegiline Propentofylline (cholinergic neurons)
Herbal drugs such as valerian, St. John’s Wort and skullcap should be avoided, especially in the cat, because their safety and effects on cognition are unquantified. Many of these drugs are general CNS depressants with sedative properties, which makes them unsuitable for treating dogs with cognitive dementia. Some, like St John’s Wort, have effects on neurotransmitters and may interact with conventional serotonergic (clomipramine) or dopaminergic (selegiline) drugs to produce adverse effects. The choice of drug should depend partly on the anticipated pathology or pathophysiology and partly on the behavioural signs of the condition being treated. The dopaminergic drug selegiline is useful for cases where there is behavioural inhibition and impaired learning because this drug increases exploratory behaviour and the intensity of the experience of reinforcement. In particular, this assists with the retraining of learned behaviours. Selegiline is also useful for cognitively impaired dogs that have fear-related problems, especially if fearfulness has increased as a result of cognitive changes. Serotonergic drugs such as clomipramine and fluoxetine are useful for animals that suffer from chronic anxiety, attachment problems and sleep disturbance. They should not be used in combination with dopaminergic drugs such as selegiline. When switching between serotonin re-uptake inhibitor and monoamine oxidase inhibitor drugs, there must be a minimum 14 day washout period, when neither drug is given, to prevent the occurrence of potentially fatal serotonin syndrome (Table 7.6). It is important to remember that while these drugs may be used in the cat, they are not licensed for this species and dose rates must be checked with current references. Changes in behaviour may be slow with psychoactive drug treatment, with a partial response seen after 4 to 6 weeks and sometimes waiting until 8 to 10 weeks for a truly significant response. Short-term drug treatments may be used to deal with problems of sleep disturbance which can be very difficult for owners to cope with. Dogs with cognitive dementia will often find it hard to get to sleep or may wake up at a specific time in the night. Chronic anxiety is linked to waking in the first third of the sleep period. In other cases, the dog wakes an hour or two before the owner is up, which creates insecurity and anxiety. The aim, if using short term sedatives, is to help the dog to sleep through the periods when it might awake and cause a disturbance but leave it fully awake during the day so that the owner can exercise it more and try to return the animal’s pattern of activity to normal. The choice of drug should be appropriate to the type of sleep disturbance, with short-acting drugs being suitable for early night-time wakefulness. Strongly sedative drugs, such as acepromazine, should be avoided where possible because they produce hangover effects that affect cognition during the daytime. Benzodiazepine drugs such as diazepam may produce a short-term sedative effect, but they too should be avoided because the memory impairment they produce
67
68
BASIC TOOLS IN BEHAVIOURAL MEDICINE
will interfere with retraining and may exacerbate some of the behavioural problems. Benzodiazepines are toxic when given orally to cats. Caution should be exercised over the prescribing of benzodiazepines due to their abuse potential in the human population. Sedative antihistamines such as trimeprazine tartrate (Vallergan®) are often very useful because they produce shortterm sedation without any after-effects. This drug works well in combination with behavioural therapy to alter sleep patterns. In most cases, sedation should be needed for only 1 to 2 weeks if other behavioural therapy is used to alter the sleep pattern.
Box 7.2 Immediate action: sleep disturbance due to cognitive dementia
Make the resting place more comfortable and familiar: ● ● ●
● ● ●
Install a night-light next to the resting place. Add a piece of the owner’s unwashed clothing. Make it well-padded with high sides so that the dog can get comfortable and feels safe. Install a DAP diffuser next to it. Keep windows closed to avoid ingress of sound. Use heavy curtains to stop the early morning light waking the dog up.
Behavioural therapy This can be divided into three components: 1. Making the environment more accessible to the geriatric pet. 2. Retraining the behaviours that the animal has lost through cognitive impairment. 3. Providing environmental enrichment to stimulate and maintain mental processes and to improve quality of life.
Increase daytime activity levels: ● ● ●
Use a short-term sedative to improve sleep: ●
Environmental modification to improve accessibility The two main problems for these dogs are locating, and then getting to, the resources they need. Pain or frustration experienced when using stairs or climbing onto furniture, for example, can make dogs irritable and aggressive. Many older dogs with back problems will object to being removed from furniture simply due to back pain. Not being able to find or comfortably visit a water bowl is a potential cause of mild dehydration, especially for any animal fed on a dried diet. Certain simple changes will make resources more useable for the less mobile pet and help to reduce competition with other animals in a multi-pet household: ● ● ●
Additional water bowls close to resting areas. Additional resting sites. Steps/ramps to get on and off furniture (if desired).
Pets with defective vision may need to be given extra cues that enable them to navigate the home: ●
●
●
Carpets and rugs to give a tactile identification of central floor spaces and corridors so that the animal can move about confidently without bumping into things. Quiet radios placed at the animal’s level in different rooms close to resources so that the animal can use sound to locate them. Different scents to identify specific rooms so that the pet can locate them.
These changes also benefit anxious or confused pets by giving them additional navigation cues. Confused animals also benefit from having properly designed bed areas, with a well-padded wrap-around basket, nearby night-light and a piece of the owner’s recently worn clothing to aid famil-
Short walks and lots of play throughout the day. Activity feeding. Wake the dog regularly the during day; don’t allow it to sleep all the time.
●
Trimeprazine tartrate (Vallergan). Small amounts of sedative lavender oil on the dog’s bedding.
iarity. Large dogs may benefit from a raised bed that is easier to get in and out of (Box 7.2).
Retraining behaviour Some behaviour, such as house-training, may be completely lost, but in many cases there is a residue of original learning that simply needs to be reactivated. It is essential to avoid using positive punishment to retrain new behaviour because this will simply cause fear and stress. Cues and reinforcement need to be clear and intelligible to the animal. Conditioned secondary reinforcers are useful because they may be tailored to the individual animal’s perceptual abilities. For example, although clicker training is often very valuable, touch or light flashes may be used as alternative conditioned reinforcers once associated with a suitably motivating reward (e.g., food). It may also be necessary to retrain the animal to reduce its attention-seeking behaviour once it is not showing signs of anxiety or confusion and will not suffer distress at being ignored.
Environmental enrichment There is no point in giving medication and a specialist diet in order to improve cognitive ability if we do nothing to stimulate the animal. Indeed, a mentally functional animal with nothing to do is a potential welfare problem.
Geriatric behavioural issues
There are some simple things that can be used to exercise the animal’s mental abilities, none of which require a lot of effort from the owner:
Activity feeding This can be as simple as scattering dried food for the pet to find, but can include homemade or manufactured feeders (Havaball®, activity ball, Buster Cube®, miniature activity balls for cats). It is best to start with very simple and undemanding exercises that replace only a small proportion of the animal’s daily food intake and then to increase the range and complexity of feeders and food-finding opportunities as the pet seems able to cope.
So, in fact, many of the processes underlying dementia in dogs are treatable, although a combination of approaches is needed in many cases. In any given individual, it is hard to assess whether signs are (temporarily) reversible or not, so it is difficult to prognosticate. Table 7.7 contains some guidelines; however, these are only approximate.
Table 7.7
Prognosis Signs (at time of presentation)
Exposure to stimulating environments Debilitated dogs
Prognosis
may not be able to walk far but they should still be taken daily to interesting places so that they can sniff around and meet other dogs and people (if this is something they have previously enjoyed). Even a couple of short (5–10 minute) periods are beneficial to an otherwise housebound dog. Low or zero-load exercise, such as swimming, is a good way to improve strength and stamina in older dogs that have become sedentary and unfit. It is also a good opportunity for fitter animals to enjoy more vigorous play and social contact with less risk of pain.
Good
Only minor signs of short duration (
